Provider Demographics
NPI:1790892750
Name:NORTHERN NECK EYE CENTER OD PC
Entity Type:Organization
Organization Name:NORTHERN NECK EYE CENTER OD PC
Other - Org Name:JAMES R PRINCE OD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:804-435-2616
Mailing Address - Street 1:853 IRVINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WEEMS
Mailing Address - State:VA
Mailing Address - Zip Code:22576-2218
Mailing Address - Country:US
Mailing Address - Phone:804-435-2616
Mailing Address - Fax:804-436-0181
Practice Address - Street 1:853 IRVINGTON RD
Practice Address - Street 2:
Practice Address - City:WEEMS
Practice Address - State:VA
Practice Address - Zip Code:22576-2218
Practice Address - Country:US
Practice Address - Phone:804-435-2616
Practice Address - Fax:804-436-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1790783181OtherMEDICARE
VA1790892750OtherMEDICARE
VA1952309221OtherMEDICARE
VA1952309221OtherMEDICARE