Provider Demographics
NPI:1801976097
Name:GROVE AVE EYE CENTER PC
Entity type:Organization
Organization Name:GROVE AVE EYE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:NEIDIGH
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:804-353-3937
Mailing Address - Street 1:3601 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2201
Mailing Address - Country:US
Mailing Address - Phone:804-358-8443
Mailing Address - Fax:804-358-1395
Practice Address - Street 1:3601 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2201
Practice Address - Country:US
Practice Address - Phone:804-358-8443
Practice Address - Fax:804-358-1395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty