Provider Demographics
NPI:1124198122
Name:NRV EYE CENTER, INC
Entity Type:Organization
Organization Name:NRV EYE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEDD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-381-2013
Mailing Address - Street 1:106 S FRANKLIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3547
Mailing Address - Country:US
Mailing Address - Phone:540-381-2013
Mailing Address - Fax:
Practice Address - Street 1:106 S FRANKLIN ST
Practice Address - Street 2:STE C
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3547
Practice Address - Country:US
Practice Address - Phone:540-381-2013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058838207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA100217Medicare PIN
VA4422950001Medicare NSC