Provider Demographics
NPI:1659483022
Name:HAMPTON ROADS RETINA CENTER
Entity Type:Organization
Organization Name:HAMPTON ROADS RETINA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADLEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-436-0011
Mailing Address - Street 1:516 INNOVATION DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3866
Mailing Address - Country:US
Mailing Address - Phone:757-436-0011
Mailing Address - Fax:757-436-0075
Practice Address - Street 1:516 INNOVATION DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3866
Practice Address - Country:US
Practice Address - Phone:757-436-0011
Practice Address - Fax:757-436-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056722174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006309895Medicaid
VA461049OtherANTHEM BCBS
NC2248749COtherCIGNA MEDICARE
VA56198OtherOPTIMA/SENTARA
VA0005088230OtherAETNA
VA461049OtherANTHEM BCBS
VA006309895Medicaid