Provider Demographics
NPI:1134319593
Name:NEW RIVER EYE CARE
Entity Type:Organization
Organization Name:NEW RIVER EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-921-4116
Mailing Address - Street 1:700 WENONAH AVE
Mailing Address - Street 2:PO BOX 438
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-1638
Mailing Address - Country:US
Mailing Address - Phone:540-921-4116
Mailing Address - Fax:540-921-4118
Practice Address - Street 1:700 WENONAH AVE
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-1638
Practice Address - Country:US
Practice Address - Phone:540-921-4116
Practice Address - Fax:540-921-4118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000990152W00000X
VA0618001654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010076404Medicaid
WV3810010274Medicaid
WV3810010274Medicaid
VAC09753Medicare PIN