Provider Demographics
NPI:1255514345
Name:HOMETOWN EYECARE, PLC
Entity type:Organization
Organization Name:HOMETOWN EYECARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-365-9090
Mailing Address - Street 1:1807 S CHURCH ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-1862
Mailing Address - Country:US
Mailing Address - Phone:757-365-9090
Mailing Address - Fax:757-365-9797
Practice Address - Street 1:1807 S CHURCH ST
Practice Address - Street 2:SUITE 114
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1862
Practice Address - Country:US
Practice Address - Phone:757-365-9090
Practice Address - Fax:757-365-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV03841Medicare UPIN