Organization
PATRICK COUNTY EYE ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY DURHAM (OFFICE MANAGER)
(276) 694-7126
Entity
Organization
Contact information
Practice address
797 WOODLAND DR, SUITE 101, STUART, VA 24171-5132
(276) 694-7126
(276) 694-7449
Mailing address
PO BOX 969, STUART, VA 24171-0969
(276) 694-7126
(276) 694-7449
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618000179
VA
152W00000X
Optometrist
Primary
0618000924
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009230602
—
VA
05
—
009230611
—
VA
Enumeration date
09/21/2012
Last updated
11/01/2012
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