CRATER VISION INC (NPI# 1497935829) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497935829 |
| Entity Type | Organization |
| Organization Name | CRATER VISION INC |
| Other Organization Name | CRATER VISION CENTER |
| Practice Address |
3333 S Crater Rd Ste 2d Petersburg VA 23805-9276 |
| Practice Telephone | 8047323937 |
| Practice Fax Number | 8077336005 |
| Mailing Telephone | 8047323937 |
| Mailing Fax Number | 8077336005 |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2017-07-06 |
| Authorized Official Name | MR. MARK E MOORE (OWNER) |
| Authorized Official Telephone | 8047323937 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 009235221 | 05 | |
| VA | BLUE CROSS | 080634 | 01 |
| Other Name | Type Code |
|---|---|
| crater vision center | Former Legal Business Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | CRATER VISION INC. | 3333 S Crater Rd Ste 2d, Petersburg, Virginia 23805-9276 |
| Street Address |
3333 S CRATER RD STE 2D |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-9276 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730289935 | Mark Edward Moore | Optometrist | 3333 S Crater Rd Ste 2d, Petersburg, VA 23805-9276 | 2006-09-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245303213 | Cheryl L Bennett | Optometrist | 28 Virginia Ave, Petersburg, WV 26847 | 2006-11-16 |
| 1730289935 | Mark Edward Moore | Optometrist | 3333 S Crater Rd Ste 2d, Petersburg, VA 23805-9276 | 2006-09-25 |
| 1275592909 | James N. Matson | Optometrist | Petersburg Medical Center, Petersburg, AK 99833 | 2006-03-21 |
| 1902808710 | Patricia Louise Testamark | Optometrist | 44 Medical Park Blvd, Ste H, Petersburg, VA 23805-9349 | 2005-08-11 |
| 1053319293 | Ajit D Tiwari | Optometrist | 300 S Sycamore St, Petersburg, VA 23803-5041 | 2005-07-12 |
| 1720525322 | Cheryl L Bennett Od Pllc | Optometrist | 28 Virginia Ave, Petersburg, WV 26847-1740 | 2017-01-21 |
| 1528322195 | Crs Optical PC | Optometrist | 715 S 9th St, Petersburg, IN 47567-1820 | 2012-06-28 |
| 1033470539 | Legacy Eye Care | Optometrist | 3500 S Crater Rd, Petersburg, VA 23805-9204 | 2012-06-01 |
| 1447511001 | Robert Joaquin Foster | Optometrist | 3500 S Crater Rd, Petersburg, VA 23805-9204 | 2012-05-30 |
| 1821327040 | Dr. Thomas H. Robertson Ltd. | Optometrist | 1980 S Sycamore St, Petersburg, VA 23805-2729 | 2009-12-17 |
| Find all providers in PETERSBURG | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.