NPIMap

Organization Active NPI

Eye Surgeons of Richmond, Inc.

  • Optometrist
  • Prince George, VA
National Provider Identifier
1093017170
Registry record updated Nov 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
19340000X Issued in VA
Legal business name
EYE SURGEONS OF RICHMOND, INC.
Practice address
2015 Waterside Rd
Prince George, VA 23875-1265
Phone
(804) 287-4200
Fax
(804) 287-4210
NPI assigned
Nov 23, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2010

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

Authorized official

Name
Mr. Eddie F. Clark, CFO
Title
Chief Financial Officer
Phone
(804) 287-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 19340000X VA Primary

Addresses

Primary practice location

2015 Waterside Rd
Prince George, VA 23875-1265

Mailing address

400 Westhampton Sta
Richmond, VA 23226-3330
Phone (804) 287-4200

Other names 1

  • Virginia Eye Institute Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040407001285 VA Part B Supplier - Clinic/Group Practice 5799778320 Receives reassigned benefits from 48 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mechanicsville, VA; Richmond, VA; Prince George, VA; Henrico, VA; Chester, VA; Midlothian, VA
O20110711000577 VA DME Supplier - Physician - OphthalmologyDME Supplier - Optician 5799778320 Practice locations: Prince George, VA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2097191Virginia Eye Institute2015 Waterside Road, Prince George, VA 23875Certificate of waiverJun 9, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Eye Surgeons of Richmond Inc2015 Waterside Road, Prince George, VA 23875-1265(804) 733-7300 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 1992

National Provider Directory

National Provider Directory
Tax ID family
Eye Surgeons of Richmond4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2015 Waterside Rd
Prince George, VA 23875
Phone (804) 733-7300

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1290470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290470400000",
    "number": "1093017170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 WESTHAMPTON STA",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232263330",
            "telephone_number": "804-287-4200",
            "fax_number": "804-287-4210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 WATERSIDE RD",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238751265",
            "telephone_number": "804-287-4200",
            "fax_number": "804-287-4210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SURGEONS OF RICHMOND, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-23",
        "last_updated": "2010-11-23",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "804-287-4200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "VA",
            "license": "19340000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Virginia Eye Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prince George, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.