Edgewater Eyecare LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618001947 Issued in VA

Legal business name

EDGEWATER EYECARE LLC

Practice address

4700 Kilgore Ave
Hampton, VA 23666-2057

Phone

(757) 825-1849

Fax

(757) 827-3261

NPI assigned

Jun 6, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Richard Andrew Nicholas, O.D.

Title

Optometrist

Phone

(757) 513-5408

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1338940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348012800000",
    "number": "1033470935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 KILGORE AVE",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236662057",
            "telephone_number": "757-825-1849",
            "fax_number": "757-827-3261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 KILGORE AVE",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236662057",
            "telephone_number": "757-825-1849",
            "fax_number": "757-827-3261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWATER EYECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-06",
        "last_updated": "2012-09-19",
        "status": "A",
        "authorized_official_last_name": "NICHOLAS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "757-513-5408",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618001947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Hampton, VA
• Providers in Hampton, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; 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.