Basic Information
| Provider Information | |||||||||
| NPI: | 1073539490 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRS RECORD & RECORD OPTOMETRISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 PETER JEFFERSON PKWY | ||||||||
| Address2: | SUITE 390 | ||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229118835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349752420 | ||||||||
| FaxNumber: | 4349790500 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 PETER JEFFERSON PKWY | ||||||||
| Address2: | SUITE 390 | ||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229118835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349752420 | ||||||||
| FaxNumber: | 4349790500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 12/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | RECORD | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | WAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 4349784090 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.