Provider Demographics
NPI:1255425591
Name:DANVILLE EYE CENTER INC
Entity type:Organization
Organization Name:DANVILLE EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:COBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-793-5500
Mailing Address - Street 1:734 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1819
Mailing Address - Country:US
Mailing Address - Phone:434-793-5500
Mailing Address - Fax:434-793-1157
Practice Address - Street 1:734 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1819
Practice Address - Country:US
Practice Address - Phone:434-793-5500
Practice Address - Fax:434-793-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029961207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE68201Medicare UPIN
C02075Medicare PIN
VAB08924Medicare UPIN