Organization
GEORGE W. PEGRAM III, O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE W. PEGRAM III O.D. (PRESIDENT)
(757) 545-3930
Entity
Organization
Contact information
Practice address
801 POINDEXTER ST, STE 115, CHESAPEAKE, VA 23324-2358
(757) 545-3930
Mailing address
801 POINDEXTER ST, STE 115, CHESAPEAKE, VA 23324-2358
(757) 545-3930
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000331
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740264662
—
VA
Enumeration date
04/06/2015
Last updated
04/06/2015
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