Provider Demographics
NPI:1639646987
Name:INFINITY EYECARE OF DANVILLE INC.
Entity Type:Organization
Organization Name:INFINITY EYECARE OF DANVILLE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/OPTICAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:434-425-4025
Mailing Address - Street 1:349 PINEY FOREST RD STE A
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4121
Mailing Address - Country:US
Mailing Address - Phone:434-425-4025
Mailing Address - Fax:
Practice Address - Street 1:349 PINEY FOREST RD STE A
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4121
Practice Address - Country:US
Practice Address - Phone:434-425-4025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========3OtherTAX ID