Provider Demographics
NPI:1467623553
Name:RICHMOND EYE & EAR HEALTH CARE
Entity Type:Organization
Organization Name:RICHMOND EYE & EAR HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-775-4500
Mailing Address - Street 1:8700 STONY POINT PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1966
Mailing Address - Country:US
Mailing Address - Phone:804-775-4500
Mailing Address - Fax:804-545-9440
Practice Address - Street 1:8700 STONY POINT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1968
Practice Address - Country:US
Practice Address - Phone:804-545-9435
Practice Address - Fax:804-545-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000920152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08849Medicare PIN