Organization
SOUTHSIDE OPTICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RIPON W LAROCHE II MD (PRESIDENT OWNER)
(434) 392-9555
Entity
Organization
Contact information
Practice address
1511 W THIRD ST, FARMVILLE, VA 23901
(434) 392-9555
(434) 392-1524
Mailing address
PO BOX 506, FARMVILLE, VA 23901-0506
(434) 392-9555
(434) 392-1524
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
528
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009280553
—
VA
Enumeration date
07/31/2006
Last updated
01/21/2010
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