Organization
OPTICAL SHOPPE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICOLE HAWLEY (OFFICE MANAGER)
(757) 484-0101
Entity
Organization
Contact information
Practice address
3206 CHURCHLAND BLVD, CHESAPEAKE, VA 23321-5206
(757) 484-0303
(757) 484-0515
Mailing address
3206 CHURCHLAND BLVD, CHESAPEAKE, VA 23321-5206
(757) 484-0303
(757) 484-0515
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
6005389
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010080371
—
VA
01
—
248303
ANTHEM
VA
Enumeration date
08/01/2006
Last updated
05/08/2008
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