Provider Demographics
NPI:1851343404
Name:VIRGINIA VISION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:VIRGINIA VISION ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BEDELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-897-0907
Mailing Address - Street 1:1101 ROYAL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4431
Mailing Address - Country:US
Mailing Address - Phone:804-897-0907
Mailing Address - Fax:
Practice Address - Street 1:671 SOUTHPARK BLVD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3617
Practice Address - Country:US
Practice Address - Phone:804-520-8290
Practice Address - Fax:804-520-8291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T00837Medicare UPIN