Organization
CLEARLY OPTOMETRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN J GREEN O. D. (PRESIDENT)
(804) 353-3555
Entity
Organization
Contact information
Practice address
2038 MONUMENT AVE, RICHMOND, VA 23220-2708
(804) 353-3555
(804) 353-9630
Mailing address
2038 MONUMENT AVE, RICHMOND, VA 23220-2708
(804) 353-3555
(804) 353-9630
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000057
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012848001
DMEPOS
VA
01
—
038113
ANTHEM
VA
01
—
22-000047
UNITED HEALTHCARE
—
01
—
586486
US HEALTHCARE
—
05
—
89-2028-1
—
VA
Enumeration date
10/30/2009
Last updated
04/28/2011
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