1578654026 NPI number — HARMAN EYE CENTER OF LYNCHBURG, LLC

Table of content: (NPI 1578654026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578654026 NPI number — HARMAN EYE CENTER OF LYNCHBURG, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARMAN EYE CENTER OF LYNCHBURG, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578654026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1290
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24551-1290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-385-5600
Provider Business Mailing Address Fax Number:
434-455-7172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2108 LANGHORNE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24501-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-845-2020
Provider Business Practice Location Address Fax Number:
434-845-2045
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURTON
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE MANAGER
Authorized Official Telephone Number:
434-385-5600

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  0101019273 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000000001677 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: CL1134 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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