Provider Demographics
NPI:1376722249
Name:EYE ASSOCIATES OF VIRGINIA
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-285-7533
Mailing Address - Street 1:5875 BREMO RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1934
Mailing Address - Country:US
Mailing Address - Phone:804-285-7533
Mailing Address - Fax:804-285-8773
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:SUITE 209
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-285-7533
Practice Address - Fax:804-285-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035231156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB05036Medicare UPIN
VAC03440Medicare PIN