Provider Demographics
NPI:1740340033
Name:COLONIAL HEIGHTS VISION CENTER OPTOMETRY, PC
Entity type:Organization
Organization Name:COLONIAL HEIGHTS VISION CENTER OPTOMETRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:804-526-9661
Mailing Address - Street 1:241 CHARLES H DIMMOCK PKWY
Mailing Address - Street 2:#3
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2915
Mailing Address - Country:US
Mailing Address - Phone:804-526-9661
Mailing Address - Fax:804-526-7987
Practice Address - Street 1:241 CHARLES H DIMMOCK PKWY
Practice Address - Street 2:#3
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2915
Practice Address - Country:US
Practice Address - Phone:804-526-9661
Practice Address - Fax:804-526-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000713152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU40884Medicare UPIN
VAC08985Medicare ID - Type Unspecified
VA5276300001Medicare NSC