Provider Demographics
NPI:1841275831
Name:NORDLUND, JOHN R (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:NORDLUND
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2010 BREMO RD STE 128A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2444
Mailing Address - Country:US
Mailing Address - Phone:757-229-4000
Mailing Address - Fax:757-220-2798
Practice Address - Street 1:5215 MONTICELLO AVE STE A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8232
Practice Address - Country:US
Practice Address - Phone:757-229-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048352207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010199361Medicaid
F26355Medicare UPIN
VA00W556W01Medicare PIN