Provider Demographics
NPI:1154406353
Name:NATIONAL OPTOMETRY STEVEN KASINOF AND 17 ASSOCIATES OPTOMETRISTS
Entity type:Organization
Organization Name:NATIONAL OPTOMETRY STEVEN KASINOF AND 17 ASSOCIATES OPTOMETRISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OD MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:MILLS
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-267-9911
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-0128
Mailing Address - Country:US
Mailing Address - Phone:717-643-1387
Mailing Address - Fax:717-643-1397
Practice Address - Street 1:2720 N MALL DR
Practice Address - Street 2:STE 108
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7200
Practice Address - Country:US
Practice Address - Phone:757-431-1111
Practice Address - Fax:757-463-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0603000168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA7681OtherRAILROAD MEDICARE
VAC06084Medicare PIN
DA7681OtherRAILROAD MEDICARE