Organization
THE EYE SPECIALISTS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIETRICH ALBERT FELLNER M.D. (PRESIDENT)
(757) 490-9091
Entity
Organization
Contact information
Practice address
813 INDEPENDENCE BLVD, VIRGINIA BEACH, VA 23455-6004
(757) 490-9091
(757) 490-3250
Mailing address
813 INDEPENDENCE BLVD, VIRGINIA BEACH, VA 23455-6004
(757) 490-9091
(757) 490-3250
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618000757
VA
207W00000X
Ophthalmology Physician
Primary
0101232452
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010030013
—
VA
01
—
0761520001
DMERC CIGNA GOVERNMENT SERVICES
VA
01
—
110252
ANTHEM BLUE CROSS
VA
01
—
C30644
RAILROAD MEDICARE
VA
Enumeration date
09/28/2006
Last updated
05/20/2008
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