Provider Demographics
NPI:1477888394
Name:TOTAL EYE OD, LLC
Entity Type:Organization
Organization Name:TOTAL EYE OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-825-8220
Mailing Address - Street 1:15189 MONTANUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-1679
Mailing Address - Country:US
Mailing Address - Phone:540-825-8220
Mailing Address - Fax:540-825-8675
Practice Address - Street 1:15189 MONTANUS DRIVE
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-1679
Practice Address - Country:US
Practice Address - Phone:540-825-8220
Practice Address - Fax:540-825-8675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C10892Medicare PIN