Basic Information
| Provider Information | |||||||||
| NPI: | 1093762965 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOMINION EYE CARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 JANAF SHOPPING CTR | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235022501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574613101 | ||||||||
| FaxNumber: | 7574616942 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 JANAF SHOPPING CTR | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235022501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574613101 | ||||||||
| FaxNumber: | 7574616942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 05/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | DEVITO | ||||||||
| AuthorizedOfficialFirstName: | KURT | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | TREASURER OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 7574613101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.