Provider Demographics
NPI:1396934709
Name:EYE CARE CENTER OF VIRGINIA PC
Entity type:Organization
Organization Name:EYE CARE CENTER OF VIRGINIA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:804-330-9303
Mailing Address - Street 1:2924 EMERYWOOD PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-3746
Mailing Address - Country:US
Mailing Address - Phone:804-330-9303
Mailing Address - Fax:804-330-9302
Practice Address - Street 1:2924 EMERYWOOD PKWY STE 103
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-3746
Practice Address - Country:US
Practice Address - Phone:804-330-9303
Practice Address - Fax:804-330-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006308287Medicaid
VADA5002OtherRAILROAD MEDICARE
VAC06920Medicare PIN