Provider Demographics
NPI:1821251919
Name:ATLANTIC VISION CARE,PC
Entity Type:Organization
Organization Name:ATLANTIC VISION CARE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:JEEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-474-2020
Mailing Address - Street 1:5224 INDIAN RIVER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6170
Mailing Address - Country:US
Mailing Address - Phone:757-474-2020
Mailing Address - Fax:
Practice Address - Street 1:5224 INDIAN RIVER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6170
Practice Address - Country:US
Practice Address - Phone:757-474-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO8993Medicare UPIN