Provider Demographics
NPI:1790837854
Name:PLATINUM EYE CARE LLC
Entity Type:Organization
Organization Name:PLATINUM EYE CARE LLC
Other - Org Name:MODERN EYES OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KANJI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-368-3937
Mailing Address - Street 1:1975 GLENN MITCHELL DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0167
Mailing Address - Country:US
Mailing Address - Phone:757-368-3937
Mailing Address - Fax:757-516-7032
Practice Address - Street 1:1975 GLENN MITCHELL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0167
Practice Address - Country:US
Practice Address - Phone:757-368-3937
Practice Address - Fax:757-516-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001467152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV0975AMedicare PIN
VAVV0977AMedicare PIN
VAVV0976AMedicare PIN
VAVAA113560Medicare PIN