Organization
GEORGE W. PEGRAM III
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE WORTHY PEGRAM III O.D. (OWNER)
(757) 545-3930
Entity
Organization
Contact information
Practice address
1109 POINDEXTER ST, CHESAPEAKE, VA 23324-2424
(757) 545-3930
(757) 545-0193
Mailing address
1109 POINDEXTER ST, CHESAPEAKE, VA 23324-2424
(757) 545-3930
(757) 545-0193
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000331
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
181445
ANTHEM BCBS
VA
01
—
227443
MDIPA
VA
Enumeration date
11/28/2006
Last updated
08/22/2020
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