Provider Demographics
NPI:1982797510
Name:VELOSO, ASHLEY C (OD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:C
Last Name:VELOSO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 CENTRAL MANOR LANDE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24823
Mailing Address - Country:US
Mailing Address - Phone:540-342-6294
Mailing Address - Fax:540-342-8201
Practice Address - Street 1:20838 TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7241
Practice Address - Country:US
Practice Address - Phone:434-239-2800
Practice Address - Fax:434-237-7037
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9232249Medicaid
VA410001159Medicare ID - Type Unspecified
VA9232249Medicaid
VA541365984002Medicare UPIN