Basic Information
Provider Information | |||||||||
NPI: | 1154406353 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NATIONAL OPTOMETRY STEVEN KASINOF AND 17 ASSOCIATES OPTOMETRISTS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NATIONAL OPTOMETRY | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 128 | ||||||||
Address2: |   | ||||||||
City: | GREENCASTLE | ||||||||
State: | PA | ||||||||
PostalCode: | 172250128 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7176431387 | ||||||||
FaxNumber: | 7176431397 | ||||||||
Practice Location | |||||||||
Address1: | 2720 N MALL DR | ||||||||
Address2: | STE 108 | ||||||||
City: | VIRGINIA BEACH | ||||||||
State: | VA | ||||||||
PostalCode: | 234527200 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7574311111 | ||||||||
FaxNumber: | 7574633387 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/26/2006 | ||||||||
LastUpdateDate: | 05/05/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FLEMING | ||||||||
AuthorizedOfficialFirstName: | PATRICK | ||||||||
AuthorizedOfficialMiddleName: | MILLS | ||||||||
AuthorizedOfficialTitleorPosition: | OD MANAGING MEMBER | ||||||||
AuthorizedOfficialTelephone: | 3042679911 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | OD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0603000168 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |   |
ID Information
ID | Type | State | Issuer | Description | DA7681 | 01 |   | RAILROAD MEDICARE | OTHER |