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TIDEWATER EYE CENTER SPC NPI 1578638748


NPI Information

NPI: 1578638748
Provider Name: TIDEWATER EYE CENTER SPC
Classification: Ophthalmology - 207W00000X
Entity Type: Organization

CLIA Number: 49D2058976

Address:
3235 ACADEMY AVE
SUITE 200
PORTSMOUTH, VA
ZIP 23703
Phone: (757) 483-0400
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TIDEWATER EYE CENTER SPC is an ophthalmology in Portsmouth, VA. The provider is an ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. TIDEWATER EYE CENTER SPC NPI is 1578638748. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3235 ACADEMY AVE
SUITE 200
PORTSMOUTH, VA
ZIP 23703-200
Phone: (757) 483-0400
Fax: (757) 673-6832

The provider's authorized official is Wayne R Devantier .
The authorized official title is President and has the following contact phone number (757) 483-0400.

The CLIA number assigned to this NPI record is 49D2058976 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/22/2006 and was last updated on 12/2/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207W00000XOphthalmologyVIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1CN4826MEDICARE PINVIRGINIA
2CH5117MEDICARE PINVIRGINIA
3C05674MEDICARE PINVIRGINIA
4CN4829MEDICARE PINVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.