Provider Demographics
NPI:1255365573
Name:PIEDMONT OPHTHALMOLOGY CLINIC, INC
Entity type:Organization
Organization Name:PIEDMONT OPHTHALMOLOGY CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:H
Authorized Official - Last Name:GAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:COE
Authorized Official - Phone:434-799-3232
Mailing Address - Street 1:800 MEMORIAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1680
Mailing Address - Country:US
Mailing Address - Phone:434-799-3232
Mailing Address - Fax:434-792-5125
Practice Address - Street 1:800 MEMORIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1680
Practice Address - Country:US
Practice Address - Phone:434-799-3232
Practice Address - Fax:434-792-5125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0197070001Medicare NSC