Provider Demographics
NPI:1568571065
Name:COMMONWEALTH EYE CARE ASSOCIATES PC
Entity Type:Organization
Organization Name:COMMONWEALTH EYE CARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:RANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-290-4278
Mailing Address - Street 1:3855 GASKINS RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1441
Mailing Address - Country:US
Mailing Address - Phone:804-217-6363
Mailing Address - Fax:804-217-6400
Practice Address - Street 1:3855 GASKINS RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1441
Practice Address - Country:US
Practice Address - Phone:804-217-6363
Practice Address - Fax:804-217-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06798Medicare UPIN