Provider Demographics
NPI:1124183744
Name:DR THOMAS E UNTERBRINK OD PC
Entity Type:Organization
Organization Name:DR THOMAS E UNTERBRINK OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:UNTERBRINK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-586-3560
Mailing Address - Street 1:130B WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-1941
Mailing Address - Country:US
Mailing Address - Phone:540-586-3560
Mailing Address - Fax:540-586-0075
Practice Address - Street 1:130B W MAIN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-1941
Practice Address - Country:US
Practice Address - Phone:540-586-3560
Practice Address - Fax:540-586-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
912204OtherEYEMED
25370OtherSPECTERA
5405863560OtherVISION SERVICE PLAN
394643OtherANTHEM
=========OtherAETNA
=========OtherVISION BENEFITS PLAN
912204OtherEYEMED
=========001OtherPIEDMONT COMM HLTHCARE
=========OtherAVESIS
=========OtherHUMANA
5405863560OtherVISION SERVICE PLAN
=========OtherWAUSAU BENEFITS INC
394643OtherANTHEM
5405863560OtherVISION SERVICE PLAN
=========OtherAETNA