Provider Demographics
NPI:1467628800
Name:DEVELOPMENTAL VISION CARE, P.C.
Entity Type:Organization
Organization Name:DEVELOPMENTAL VISION CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WESTCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-410-3005
Mailing Address - Street 1:601 INNOVATION DR STE B
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3869
Mailing Address - Country:US
Mailing Address - Phone:757-410-3005
Mailing Address - Fax:757-410-3335
Practice Address - Street 1:601 INNOVATION DR STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3869
Practice Address - Country:US
Practice Address - Phone:757-410-3005
Practice Address - Fax:757-410-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0603000304152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VASVA038Medicare PIN
VAC09650Medicare PIN