Provider Demographics
NPI:1922477967
Name:SHORT PUMP FAMILY EYE CARE, PLLC
Entity Type:Organization
Organization Name:SHORT PUMP FAMILY EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-365-2111
Mailing Address - Street 1:11591 W BROAD ST STE C
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1186
Mailing Address - Country:US
Mailing Address - Phone:804-364-0823
Mailing Address - Fax:804-364-8943
Practice Address - Street 1:11591 W BROAD ST STE C
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1186
Practice Address - Country:US
Practice Address - Phone:804-364-0823
Practice Address - Fax:804-364-8943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001941152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty