Provider Demographics
NPI:1942385786
Name:MADISON HEIGHTS EYE CARE PC OPTOMETRISTS
Entity Type:Organization
Organization Name:MADISON HEIGHTS EYE CARE PC OPTOMETRISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:434-846-7822
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-1000
Mailing Address - Country:US
Mailing Address - Phone:434-846-7822
Mailing Address - Fax:434-846-8107
Practice Address - Street 1:5076 SOUTH AMHERST HWY
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572
Practice Address - Country:US
Practice Address - Phone:434-846-7822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1252770001Medicare NSC