Provider Demographics
NPI:1447410618
Name:ADVANCED EYE CENTER, INC
Entity Type:Organization
Organization Name:ADVANCED EYE CENTER, INC
Other - Org Name:ROUTE 20/20 VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLOPFER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-854-2255
Mailing Address - Street 1:PO BOX 2616
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-8616
Mailing Address - Country:US
Mailing Address - Phone:540-854-2255
Mailing Address - Fax:
Practice Address - Street 1:32511 CONSTITUTION HWY
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-2711
Practice Address - Country:US
Practice Address - Phone:540-854-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED EYE CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-11
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1396805784Medicaid
VAC10600Medicare PIN