Organization
SOUTHSIDE EYE CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL R KEVERLINE MD (OWNER)
(757) 484-0101
Entity
Organization
Contact information
Practice address
3206 CHURCHLAND BLVD, CHESAPEAKE, VA 23321-5206
(757) 484-0101
(757) 484-0515
Mailing address
3206 CHURCHLAND BLVD, CHESAPEAKE, VA 23321-5206
(757) 484-0101
(757) 484-0515
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000583
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89015TY
—
NC
Enumeration date
10/18/2005
Last updated
06/15/2015
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