Petersburg Family Eye Care

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618000693 Issued in VA

Legal business name

PETERSBURG FAMILY EYE CARE

Practice address

44 Medical Park Blvd
Ste H
Petersburg, VA 23805-9349

Phone

(804) 898-3373

Fax

(804) 479-3775

NPI assigned

Jun 14, 2007

Last updated

Sep 22, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Patricia L Testamark, O.D.NPI 1902808710

Title

Doctor

Phone

(804) 898-3373

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA2 enrollments

Enrollment records 2

Locations

Practitioners 1

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.

• Patricia Louise Testamark, OD

  • Optometrist
  • Petersburg, VA
  • NPI 1902808710
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442880000000",
    "number": "1396949046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 MEDICAL PARK BLVD",
            "address_2": "STE H",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059349",
            "telephone_number": "804-898-3373",
            "fax_number": "804-479-3775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 MEDICAL PARK BLVD",
            "address_2": "STE H",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059349",
            "telephone_number": "804-898-3373",
            "fax_number": "804-479-3775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSBURG FAMILY EYE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2015-09-22",
        "status": "A",
        "authorized_official_last_name": "TESTAMARK",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "804-898-3373",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010315891",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Petersburg Adult Healthcare
• Petersburg Case Management & Services
• Petersburg Clinic Company LLC
• Petersburg Complete Dental Care PLLC
• Petersburg Dermatology, PC
• Petersburg Home Care Services LLC (Southside Regional Home Health)
• Petersburg Hospital Company LLC (Southside Regional Medical Center)
• Petersburg Hospital Company LLC (Southside Regional Medical Center)
• Petersburg Hospital Company LLC (Southside Regional Medical Center - Renal Services)
• Petersburg Hospital Company LLC (Southside Regional Medical Center)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2015; 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.