Provider Demographics
NPI:1497062913
Name:DR FRANK VILLA OPTOMETRIST PC
Entity Type:Organization
Organization Name:DR FRANK VILLA OPTOMETRIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:BENEDICT
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:434-385-8800
Mailing Address - Street 1:18800 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4494
Mailing Address - Country:US
Mailing Address - Phone:434-385-8800
Mailing Address - Fax:
Practice Address - Street 1:18800 FOREST RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4494
Practice Address - Country:US
Practice Address - Phone:434-385-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000190152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA92-30084Medicaid
VA92-30084Medicaid
VA410001053Medicare PIN