Organization
VIRGINIA PEDIATRIC OPHTHALMOLOGY SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWIN WORTHAM V M.D. (OWNER)
(804) 272-8040
Entity
Organization
Contact information
Practice address
8720 STONY POINT PKWY, SUITE 135, RICHMOND, VA 23235-1962
(804) 272-8040
(804) 272-7344
Mailing address
8720 STONY POINT PKWY, SUITE 135, RICHMOND, VA 23235-1962
(804) 272-8040
(804) 272-7344
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101047478
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010271259
MEDICAL LICENSE
VA
Enumeration date
11/15/2011
Last updated
03/16/2021
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