NPIMap

Organization Active NPI

Family Vision Care of Richmond

  • Optometrist
  • Glen Allen, VA
National Provider Identifier
1336361997
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
FAMILY VISION CARE OF RICHMOND
Practice address
4028 Cox Rd Ste M
Glen Allen, VA 23060-6702
Phone
(804) 217-9883
Fax
(804) 217-9065
NPI assigned
May 3, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Tracy Poling, ODNPI 1851370985
Title
Secretary
Phone
(804) 217-9883

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

4028 Cox Rd Ste M
Glen Allen, VA 23060-6702

Mailing address

4028 Cox Rd Ste M
Glen Allen, VA 23060-6702

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090429000456 VA Part B Supplier - Clinic/Group Practice 6103974217 Receives reassigned benefits from 10 practitioners
Practice locations: Ashland, VA; Glen Allen, VA
O20100930016623 VA DME Supplier - Physician - OptometristDME Supplier - Optician 6103974217 Practice locations: Glen Allen, VA

National Provider Directory

National Provider Directory

Locations

4028 Cox Rd
Ste M
Glen Allen, VA 23060
Phone (804) 217-9883

4114 Innslake Dr
Glen Allen, VA 23060
Phone (804) 217-9883

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336361997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4028 COX RD STE M",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230606702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4028 COX RD STE M",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230606702",
            "telephone_number": "804-217-9883",
            "fax_number": "804-217-9065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY VISION CARE OF RICHMOND",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POLING",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "804-217-9883",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Allen, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.