Provider Demographics
NPI:1760554810
Name:DOMINION EYE ASSOCIATES PC
Entity Type:Organization
Organization Name:DOMINION EYE ASSOCIATES PC
Other - Org Name:DOMINION EYE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKSHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVE'
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-285-0680
Mailing Address - Street 1:2010 BREMO RD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2444
Mailing Address - Country:US
Mailing Address - Phone:804-285-0680
Mailing Address - Fax:804-282-6365
Practice Address - Street 1:2010 BREMO RD
Practice Address - Street 2:SUITE 128
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2444
Practice Address - Country:US
Practice Address - Phone:804-285-0680
Practice Address - Fax:804-282-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006307884Medicaid
VAF96923Medicare UPIN
VA006307884Medicaid