Provider Demographics
NPI:1306933536
Name:AFTEL & RADER, OPTOMETRISTS, P.L.C.
Entity type:Organization
Organization Name:AFTEL & RADER, OPTOMETRISTS, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RADER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-488-0192
Mailing Address - Street 1:5913 PORTSMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-1445
Mailing Address - Country:US
Mailing Address - Phone:757-488-0192
Mailing Address - Fax:757-488-4567
Practice Address - Street 1:5913 PORTSMOUTH BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-1445
Practice Address - Country:US
Practice Address - Phone:757-488-0192
Practice Address - Fax:757-488-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009231064Medicaid
VA410033892OtherMEDICARE-RAILROAD
VA261285OtherBCBS/G. THOMAS RADER,O.D.
VA25074OtherOPTIMA/G. THOMAS RADER,OD
VA229196OtherMAMSI- G. THOMAS RADER,OD
0202070001Medicare NSC
VA25074OtherOPTIMA/G. THOMAS RADER,OD
VA009231064Medicaid