Provider Demographics
NPI:1104333871
Name:STONY POINT FAMILY EYECARE, INC.
Entity type:Organization
Organization Name:STONY POINT FAMILY EYECARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/ CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-849-4955
Mailing Address - Street 1:9200 STONY POINT PKWY STE 195B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1973
Mailing Address - Country:US
Mailing Address - Phone:678-849-4955
Mailing Address - Fax:
Practice Address - Street 1:9200 STONY POINT PKWY STE 195B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1973
Practice Address - Country:US
Practice Address - Phone:804-272-0847
Practice Address - Fax:804-272-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty