Provider Demographics
NPI:1659469567
Name:FARMVILLE VISION CENTER INC
Entity Type:Organization
Organization Name:FARMVILLE VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOURQUREAN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTCIAN
Authorized Official - Phone:434-392-8408
Mailing Address - Street 1:COLLEGE PLAZA SHOPPING CENTER
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901
Mailing Address - Country:US
Mailing Address - Phone:434-392-8408
Mailing Address - Fax:434-392-8408
Practice Address - Street 1:COLLEGE PLAZA SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901
Practice Address - Country:US
Practice Address - Phone:434-392-8408
Practice Address - Fax:434-392-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101 002474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA204661OtherANTHEM
VA25662OtherSPECTERA
VA9282581Medicaid
VA204661OtherANTHEM