Organization
COMMONWEALTH VISION CENTER P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONARD BRINKLEY WHITESIDE III OD (PRESIDENT)
(434) 292-6393
Entity
Organization
Contact information
Practice address
1447 SOUTH MAIN STREET, BLACKSTONE, VA 23824
(434) 292-6393
(434) 292-3266
Mailing address
1447 SOUTH MAIN STREET, BLACKSTONE, VA 23824-2626
(434) 292-6393
(434) 292-3266
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000199
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
463891
ANTHEM
VA
Enumeration date
10/10/2006
Last updated
10/19/2009
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