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Eye Physicians of Southwest Virginia P C

Organization Active NPI Ophthalmology Physician · Abingdon, VA

NPI 1154315901 · NPPES record last updated Mar 28, 2023

Key facts

NPI
1154315901
Entity type
Organization (NPI type 2)
Primary specialty
Ophthalmology Physician 207W00000X
Legal business name
EYE PHYSICIANS OF SOUTHWEST VIRGINIA P C
Practice address
340 W Main St
Abingdon, VA 24210-2624
Phone
(276) 628-3118
Fax
(276) 628-8342
NPI assigned
Sep 8, 2005
Organization subpart
No

Authorized official

Name
Justin Trent
Title
Administrator
Phone
(276) 628-3118

Corporate family (same tax ID) 2

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

Practitioners 12

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in VA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050502000625 VA Part B Supplier - Clinic/Group Practice 3173562808 Receives reassigned benefits from 8 practitioners
Practice locations: Wytheville, VA; Marion, VA; Bristol, VA; Abingdon, VA; Clintwood, VA
O20100930063271 VA DME Supplier - Physician - Ophthalmology
DME Supplier - Optician		 3173562808 Practice locations: Abingdon, VA

National Provider Directory

Tax ID family
Eye Physicians of Southwest (3 organizations share this tax ID)

Locations

340 W Main St
Abingdon, VA 24210
Phone (276) 628-3118

328 Cummings St
Ste A
Abingdon, VA 24210
Phone (276) 477-4600

328 Cummings St
Abingdon, VA 24210

761 Commonwealth Ave
Bristol, VA 24201
Phone (276) 466-3420

1128 N Main St
Marion, VA 24354
Phone (276) 783-6131

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207W00000X Yes

Addresses

Primary practice location

340 W Main St
Abingdon, VA 24210-2624

Mailing address

340 W Main St
Abingdon, VA 24210-2624
Phone (276) 628-3118

Other identifiers

IdentifierTypeStateIssuer
CM6002OtherVARAILROAD MEDICARE

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 28, 2023.

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679961600000",
    "number": "1154315901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 W MAIN ST",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242102624",
            "telephone_number": "276-628-3118",
            "fax_number": "276-628-8342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 W MAIN ST",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242102624",
            "telephone_number": "276-628-3118",
            "fax_number": "276-628-8342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE PHYSICIANS OF SOUTHWEST VIRGINIA P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-08",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A",
        "authorized_official_last_name": "TRENT",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "276-628-3118"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CM6002",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Abingdon, VA

All providers in Abingdon, VA · Ophthalmology Physician in Virginia

Sources for this page

Verify at the official NPI Registry.