Provider Demographics
NPI:1619068640
Name:EYE CARE CHRISTIANSBURG INC
Entity Type:Organization
Organization Name:EYE CARE CHRISTIANSBURG INC
Other - Org Name:INVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-381-2020
Mailing Address - Street 1:29 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-2941
Mailing Address - Country:US
Mailing Address - Phone:540-381-2020
Mailing Address - Fax:540-382-2660
Practice Address - Street 1:29 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-2941
Practice Address - Country:US
Practice Address - Phone:540-381-2020
Practice Address - Fax:540-382-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601001355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9202552Medicaid
VA465995OtherANTHEM
VA4721480001Medicare NSC
VA9202552Medicaid