Provider Demographics
NPI:1114913381
Name:MEADOWS, GEMMA C (OD)
Entity Type:Individual
Prefix:DR
First Name:GEMMA
Middle Name:C
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3449 GEORGE WASHINGTON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-3100
Mailing Address - Country:US
Mailing Address - Phone:804-642-2290
Mailing Address - Fax:804-684-2166
Practice Address - Street 1:3449 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3100
Practice Address - Country:US
Practice Address - Phone:804-642-2290
Practice Address - Fax:804-684-2166
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA#0601800455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010026920Medicaid
VA010026920Medicaid
VAU91597Medicare UPIN