Provider Demographics
NPI:1457444309
Name:COMMONWEALTH EYE CENTER, PC
Entity Type:Organization
Organization Name:COMMONWEALTH EYE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:BREAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-825-3655
Mailing Address - Street 1:633 SUNSET LN
Mailing Address - Street 2:SUITE E
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3942
Mailing Address - Country:US
Mailing Address - Phone:540-825-3655
Mailing Address - Fax:540-825-5574
Practice Address - Street 1:633 SUNSET LN
Practice Address - Street 2:SUITE E
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3942
Practice Address - Country:US
Practice Address - Phone:540-825-3655
Practice Address - Fax:540-825-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE07116Medicare UPIN
VACO3674Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
VA6131890001Medicare NSC
VA180000454Medicare ID - Type Unspecified