Basic Information
| Provider Information | |||||||||
| NPI: | 1467485763 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSIGHT VISION CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 POLLARD PARK | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231854067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572919276 | ||||||||
| FaxNumber: | 7578104201 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 DUTCHMANS LN | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216013346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108224000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 06/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | VAN DYCK | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | TUCKER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7572919276 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | DA1986 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.