Provider Demographics
NPI:1154458792
Name:INSIGHT OPTOMETRIST, P.C.
Entity Type:Organization
Organization Name:INSIGHT OPTOMETRIST, P.C.
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:S
Authorized Official - Last Name:BORZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-463-2136
Mailing Address - Street 1:701 LYNNHAVEN PKWY
Mailing Address - Street 2:SUITE 1189
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7299
Mailing Address - Country:US
Mailing Address - Phone:757-463-2136
Mailing Address - Fax:757-463-8917
Practice Address - Street 1:701 LYNNHAVEN PKWY
Practice Address - Street 2:SUITE 1189
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7299
Practice Address - Country:US
Practice Address - Phone:757-463-2136
Practice Address - Fax:757-463-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0999600001Medicare NSC