Provider Demographics
NPI:1114784246
Name:EYE CARE CENTER OF VIRGINIA SURGICAL SERVICES LLC
Entity Type:Organization
Organization Name:EYE CARE CENTER OF VIRGINIA SURGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-330-9303
Mailing Address - Street 1:2924 EMERYWOOD PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-3746
Mailing Address - Country:US
Mailing Address - Phone:804-330-9303
Mailing Address - Fax:
Practice Address - Street 1:2924 EMERYWOOD PKWY STE 103
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-3746
Practice Address - Country:US
Practice Address - Phone:804-330-9303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery