Provider Demographics
NPI:1568693992
Name:DAVID R. FARMER OD PC
Entity Type:Organization
Organization Name:DAVID R. FARMER OD PC
Other - Org Name:DAVID R. FARMER, OD PC D/B/A KEMPSVILLE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-467-6200
Mailing Address - Street 1:5308 PROVIDENCE ROAD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4102
Mailing Address - Country:US
Mailing Address - Phone:757-467-6200
Mailing Address - Fax:
Practice Address - Street 1:5308 PROVIDENCE ROAD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4102
Practice Address - Country:US
Practice Address - Phone:757-467-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000044152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT21663Medicare UPIN
VAC10756Medicare PIN