Provider Demographics
NPI:1497765739
Name:DRS GILBERT & FARLEY ODPC
Entity Type:Organization
Organization Name:DRS GILBERT & FARLEY ODPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORP DR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:H
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-526-3676
Mailing Address - Street 1:3731 A BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834
Mailing Address - Country:US
Mailing Address - Phone:804-526-3676
Mailing Address - Fax:804-520-5781
Practice Address - Street 1:3731 A BOULEVARD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834
Practice Address - Country:US
Practice Address - Phone:804-526-3676
Practice Address - Fax:804-520-5781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000164152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC01947Medicare PIN
VA0210760001Medicare NSC