Provider Demographics
NPI:1619149945
Name:MITREV EYE CENTER, PC
Entity Type:Organization
Organization Name:MITREV EYE CENTER, PC
Other - Org Name:PETER M. MITREV, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:V
Authorized Official - Last Name:MITREV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-382-9400
Mailing Address - Street 1:516 INNOVATION DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4988
Mailing Address - Country:US
Mailing Address - Phone:757-382-9400
Mailing Address - Fax:757-436-6201
Practice Address - Street 1:516 INNOVATION DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4988
Practice Address - Country:US
Practice Address - Phone:757-382-9400
Practice Address - Fax:757-436-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222101207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAGC1117Medicare PIN