Provider Demographics
NPI:1982613576
Name:EYE ONE, PLC
Entity Type:Organization
Organization Name:EYE ONE, PLC
Other - Org Name:AUGUSTA EYE ASSOCIATES, P.L.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:VANDEVANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-213-8449
Mailing Address - Street 1:17 N. MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939
Mailing Address - Country:US
Mailing Address - Phone:540-213-7720
Mailing Address - Fax:540-213-7481
Practice Address - Street 1:17 N. MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-213-7720
Practice Address - Fax:540-213-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1891881207Medicaid
VA1902999535Medicaid
VA1487748026Medicaid
VA1487748026Medicaid
1002070001Medicare NSC
1002070003Medicare NSC