Provider Demographics
NPI:1982092235
Name:EYE DOCTOR MD PC
Entity Type:Organization
Organization Name:EYE DOCTOR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHILPI
Authorized Official - Middle Name:
Authorized Official - Last Name:PRADHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-819-2571
Mailing Address - Street 1:3960 STILLMAN PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4197
Mailing Address - Country:US
Mailing Address - Phone:804-270-3333
Mailing Address - Fax:804-270-9333
Practice Address - Street 1:3960 STILLMAN PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4197
Practice Address - Country:US
Practice Address - Phone:804-270-3333
Practice Address - Fax:804-270-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2015133730Medicaid
VAE321OtherMEDICARE