Provider Demographics
NPI:1295901874
Name:DOMINION EYECARE PLLC
Entity type:Organization
Organization Name:DOMINION EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-420-2053
Mailing Address - Street 1:6113 INDIAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3503
Mailing Address - Country:US
Mailing Address - Phone:757-420-2053
Mailing Address - Fax:757-424-9503
Practice Address - Street 1:6113 INDIAN RIVER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3503
Practice Address - Country:US
Practice Address - Phone:757-420-2053
Practice Address - Fax:757-424-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009236465Medicaid
VA410001278Medicare PIN
VA4323400001Medicare NSC
VAT21804Medicare UPIN