Provider Demographics
NPI:1144250804
Name:PETER E. WILCOX, OD, PLC
Entity type:Organization
Organization Name:PETER E. WILCOX, OD, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR
Authorized Official - Phone:804-642-9800
Mailing Address - Street 1:2652 GEORGE WASHINGTON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-3464
Mailing Address - Country:US
Mailing Address - Phone:804-642-9800
Mailing Address - Fax:804-642-0334
Practice Address - Street 1:2652 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3464
Practice Address - Country:US
Practice Address - Phone:804-642-9800
Practice Address - Fax:804-642-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0603000338152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C05917Medicare PIN
1250960001Medicare NSC
VAU19011Medicare UPIN