1982863684 NPI number — NATIONAL OPTICAL

Table of content: (NPI 1982863684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982863684 NPI number — NATIONAL OPTICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL OPTICAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982863684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4135 FRANKLIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018-5703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-776-2933
Provider Business Mailing Address Fax Number:
540-776-2932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4135 FRANKLIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24018-5703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-776-2933
Provider Business Practice Location Address Fax Number:
540-776-2932
Provider Enumeration Date:
06/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
540-776-2933

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  1434 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009280529 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: VA1425 . This is a "EYE MED" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 05098 . This is a "SPECTERA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 079880 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5678 . This is a "DAVIS VISION" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com