Provider Demographics
NPI:1427033174
Name:POLLOCK, EARL M (OD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:M
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3282 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5261
Mailing Address - Country:US
Mailing Address - Phone:757-484-8080
Mailing Address - Fax:757-483-6310
Practice Address - Street 1:3282 WESTERN BRANCH BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5261
Practice Address - Country:US
Practice Address - Phone:757-484-8080
Practice Address - Fax:757-483-6310
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000197152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9230009Medicaid
VAP00441581Medicare PIN
VA580000037Medicare ID - Type Unspecified
VA0646450001Medicare NSC
VA580000037Medicare PIN
VA9230009Medicaid