Provider Demographics
NPI:1912390485
Name:ISITE, LLC
Entity Type:Organization
Organization Name:ISITE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KULSOOM
Authorized Official - Middle Name:T
Authorized Official - Last Name:MURTAZA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-712-3360
Mailing Address - Street 1:11703 ANCHOR LANDING PL
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-5422
Mailing Address - Country:US
Mailing Address - Phone:804-712-3360
Mailing Address - Fax:
Practice Address - Street 1:11703 ANCHOR LANDING PL
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-5422
Practice Address - Country:US
Practice Address - Phone:804-712-3360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty