Provider Demographics
NPI:1669576393
Name:EYE CENTER INC
Entity type:Organization
Organization Name:EYE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIPSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-288-1543
Mailing Address - Street 1:3701 WESTERRE PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1326
Mailing Address - Country:US
Mailing Address - Phone:804-288-1543
Mailing Address - Fax:804-285-2375
Practice Address - Street 1:3701 WESTERRE PARKWAY
Practice Address - Street 2:STE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233
Practice Address - Country:US
Practice Address - Phone:804-288-1543
Practice Address - Fax:804-285-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACD3508OtherPALMETTO GBA
VAB06362Medicare UPIN
VACD3508OtherPALMETTO GBA