Provider Demographics
NPI:1669547311
Name:OLD DOMINION EYE CARE INC
Entity type:Organization
Organization Name:OLD DOMINION EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:H
Authorized Official - Last Name:WEILER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-435-0547
Mailing Address - Street 1:101 TECHNOLOGY PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482
Mailing Address - Country:US
Mailing Address - Phone:804-435-0547
Mailing Address - Fax:804-435-2712
Practice Address - Street 1:101 TECHNOLOGY PARK DRIVE
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-0547
Practice Address - Fax:804-435-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC15121OtherRAILROAD MEDICARE
VAC02399Medicare PIN