Provider Demographics
NPI:1689908493
Name:DRS. DEVITO & MARTIN OD
Entity Type:Organization
Organization Name:DRS. DEVITO & MARTIN OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:K
Authorized Official - Last Name:DEVITO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-461-3101
Mailing Address - Street 1:5900 E VIRGINIA BEACH BLVD
Mailing Address - Street 2:125 JANAF SHOPPING CENTER
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2473
Mailing Address - Country:US
Mailing Address - Phone:757-461-3101
Mailing Address - Fax:757-461-6942
Practice Address - Street 1:5900 E VIRGINIA BEACH BLVD
Practice Address - Street 2:125 JANAF SHOPPING CENTER
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2473
Practice Address - Country:US
Practice Address - Phone:757-461-3101
Practice Address - Fax:757-461-6942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0656570001Medicare NSC