Basic Information
| Provider Information | |||||||||
| NPI: | 1689908493 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRS. DEVITO & MARTIN OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5900 E VIRGINIA BEACH BLVD | ||||||||
| Address2: | 125 JANAF SHOPPING CENTER | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235022473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574613101 | ||||||||
| FaxNumber: | 7574616942 | ||||||||
| Practice Location | |||||||||
| Address1: | 5900 E VIRGINIA BEACH BLVD | ||||||||
| Address2: | 125 JANAF SHOPPING CENTER | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235022473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574613101 | ||||||||
| FaxNumber: | 7574616942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2009 | ||||||||
| LastUpdateDate: | 05/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | DEVITO | ||||||||
| AuthorizedOfficialFirstName: | KURT | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7574613101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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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.