Provider Demographics
NPI:1790098325
Name:OPTOMETRIC SERVICES
Entity Type:Organization
Organization Name:OPTOMETRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BRAUN
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-705-3082
Mailing Address - Street 1:792 OLD CUTLER RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-6050
Mailing Address - Country:US
Mailing Address - Phone:757-705-3082
Mailing Address - Fax:757-340-0891
Practice Address - Street 1:792 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-6050
Practice Address - Country:US
Practice Address - Phone:757-705-3082
Practice Address - Fax:757-340-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-25
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty