Kulsoom T Murtaza, OD | |
2015 Waterside Rd, Prince George, VA 23875-1265 | |
(804) 733-7300 | |
(804) 733-7390 |
Full Name | Kulsoom T Murtaza |
---|---|
Gender | Female |
Speciality | Optometrist |
Location | 2015 Waterside Rd, Prince George, Virginia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1639181472 | NPI | - | NPPES |
KM003908 | Other | MI | STATE LICENSE NUMBER |
900C363570 | Other | MI | BLUE CROSS BLUE SHIELD |
200000002790 | Other | MI | PHPMM |
0618001931 | Other | VA | STATE LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 0618001931 (Virginia) | Primary |
Provider Name | Legacy Eye Care |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1033470539 PECOS PAC ID: 7214185057 Enrollment ID: O20120919000665 |
Mailing Address | Practice Location Address |
---|---|
Kulsoom T Murtaza, OD 400 Westhampton Sta, Richmond, VA 23226-3330 Ph: (804) 287-4200 | Kulsoom T Murtaza, OD 2015 Waterside Rd, Prince George, VA 23875-1265 Ph: (804) 733-7300 |
Virginia Eye Institute Optometrist Medicare: Medicare Enrolled Practice Location: 2015 Waterside Rd, Prince George, VA 23875 Phone: 804-287-4200 Fax: 804-287-4210 | |
Dr. Justin Autry, O.D. Optometrist Medicare: Not Enrolled in Medicare Practice Location: 2015 Waterside Rd, Prince George, VA 23875 Phone: 804-733-7300 Fax: 804-733-7387 | |
Thomas Matlock Wyman, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 2015 Waterside Rd, Prince George, VA 23875 Phone: 804-287-4200 |