Provider Demographics
NPI:1023127800
Name:JAMES RIVER OPTICAL LLC
Entity type:Organization
Organization Name:JAMES RIVER OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD MS
Authorized Official - Phone:757-595-3252
Mailing Address - Street 1:704 THIMBLE SHOALS BVD
Mailing Address - Street 2:#100
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606
Mailing Address - Country:US
Mailing Address - Phone:757-595-3252
Mailing Address - Fax:757-595-8353
Practice Address - Street 1:704 THIMBLE SHOALS BVD
Practice Address - Street 2:#100
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-595-3252
Practice Address - Fax:757-595-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS1588534332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5635170001Medicare NSC