Provider Demographics
NPI:1174649446
Name:CANNADY, DAMON (REGISTERED OPTICIAN)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:CANNADY
Suffix:
Gender:M
Credentials:REGISTERED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SOUTHPARK BLVD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3617
Mailing Address - Country:US
Mailing Address - Phone:804-520-4687
Mailing Address - Fax:804-520-4688
Practice Address - Street 1:621 SOUTHPARK BLVD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3617
Practice Address - Country:US
Practice Address - Phone:804-520-4687
Practice Address - Fax:804-520-4688
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101 002127156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician