Tidewater Eye Center Spc
NPI #1578638748 in Portsmouth, Virginia
Provider Information
- NPI Number
- 1578638748
- Entity Type
- Organization
- Organization Name
- Tidewater Eye Center Spc
- Primary Specialty
- Ophthalmology
- Enumeration Date
- Nov 22, 2006
- Last Updated
- Dec 2, 2014
Practice Location
- Address
- 3235 ACADEMY AVE
- Address 2
- SUITE 200
- City
- Portsmouth
- State
- Virginia
- ZIP Code
- 23703-3200
- Phone
- (757) 483-0400
Authorized Official
- Name
- DR. WAYNE R DEVANTIER, MD
- Title
- PRESIDENT
- Phone
- (757) 483-0400
Specialties & Taxonomy Codes
| Specialty |
|---|
| Ophthalmology |
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