Organization
COMMONWEALTH VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONARD BRINKLEY WHITESIDE III OD (PRES)
(804) 346-9100
Entity
Organization
Contact information
Practice address
10220 WEST BROAD STREET, GLEN ALLEN, VA 23060-3305
(804) 346-9100
(804) 527-5393
Mailing address
10220 WEST BROAD STREET, GLEN ALLEN, VA 23060-3305
(804) 346-9100
(804) 527-5393
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000199
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230283
ANTHEM
VA
Enumeration date
10/27/2006
Last updated
08/22/2020
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