Provider Demographics
NPI:1124197843
Name:CHESAPEAKE EYE PHYSICIANS OPTICAL
Entity Type:Organization
Organization Name:CHESAPEAKE EYE PHYSICIANS OPTICAL
Other - Org Name:CHESAPEAKE EYE CARE AND LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VIOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-410-9500
Mailing Address - Street 1:560 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3621
Mailing Address - Country:US
Mailing Address - Phone:757-410-9500
Mailing Address - Fax:757-410-9507
Practice Address - Street 1:560 KEMPSVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3621
Practice Address - Country:US
Practice Address - Phone:757-410-9500
Practice Address - Fax:757-410-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5199830001Medicare NSC