Provider Demographics
NPI:1083859433
Name:SOUTHERN VIRGINIA EYECARE LLC
Entity Type:Organization
Organization Name:SOUTHERN VIRGINIA EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DANHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-953-8838
Mailing Address - Street 1:916 WEST ATLANTIC ST
Mailing Address - Street 2:BOX 132
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1248
Mailing Address - Country:US
Mailing Address - Phone:757-953-8838
Mailing Address - Fax:757-351-6268
Practice Address - Street 1:916 W ATALANTIC ST
Practice Address - Street 2:BOX 132
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1217
Practice Address - Country:US
Practice Address - Phone:757-953-8838
Practice Address - Fax:757-351-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01608001606152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10646Medicare PIN