Provider Demographics
NPI:1154315901
Name:EYE PHYSICIANS OF SOUTHWEST VIRGINIA P C
Entity Type:Organization
Organization Name:EYE PHYSICIANS OF SOUTHWEST VIRGINIA P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-628-3118
Mailing Address - Street 1:340 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2624
Mailing Address - Country:US
Mailing Address - Phone:276-628-3118
Mailing Address - Fax:276-628-8342
Practice Address - Street 1:340 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2624
Practice Address - Country:US
Practice Address - Phone:276-628-3118
Practice Address - Fax:276-628-8342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACM6002OtherRAILROAD MEDICARE
VAC05974Medicare PIN
VAC02387Medicare PIN
VA0221430001Medicare NSC
VAC05974Medicare PIN