Ophthalmic Consultants of Tidewater PC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

OPHTHALMIC CONSULTANTS OF TIDEWATER PC

Doing business as

MID ATLANTIC EYE CARE

Practice address

109 Wimbledon SQ
Suite E
Chesapeake, VA 23320-4945

Phone

(757) 547-9830

Fax

(757) 548-0721

NPI assigned

Sep 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Rose Ann Waller

Title

Practice Manager

Phone

(757) 547-9830

Specialties & licenses 1

Addresses

Other names 1

• MID ATLANTIC EYE CARE Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424390400000",
    "number": "1013008861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 WIMBLEDON SQ",
            "address_2": "SUITE E",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233204945",
            "telephone_number": "757-547-9830",
            "fax_number": "757-548-0721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 WIMBLEDON SQ",
            "address_2": "SUITE E",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233204945",
            "telephone_number": "757-547-9830",
            "fax_number": "757-548-0721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPHTHALMIC CONSULTANTS OF TIDEWATER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2015-02-20",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "ROSE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "757-547-9830",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MID ATLANTIC EYE CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.