Provider Demographics
NPI:1720177322
Name:DR JOHN C DRAGON OD & ASSOCIATES
Entity Type:Organization
Organization Name:DR JOHN C DRAGON OD & ASSOCIATES
Other - Org Name:SOUTHERN EYECARE ASSOCIATES, OPTOMETRISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:DRAGON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-588-5423
Mailing Address - Street 1:7525 TIDEWATER DR
Mailing Address - Street 2:SUITE 41
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3700
Mailing Address - Country:US
Mailing Address - Phone:757-588-5423
Mailing Address - Fax:757-588-6012
Practice Address - Street 1:7525 TIDEWATER DR
Practice Address - Street 2:SUITE 41
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3700
Practice Address - Country:US
Practice Address - Phone:757-588-5423
Practice Address - Fax:757-588-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9234462Medicaid
VA0322710001Medicare NSC
VAC02109Medicare PIN