1407823438 NPI number — NATIONAL OPTICAL

Table of content: (NPI 1407823438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407823438 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:
1407823438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1507 HERSHBERGER RD NW
Provider Second Line Business Mailing Address:
UNIT C
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24012-7319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-362-0300
Provider Business Mailing Address Fax Number:
540-362-5574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W VIRGINIA AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
VINTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24179-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-343-4252
Provider Business Practice Location Address Fax Number:
540-343-4624
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
T
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
540-362-0300

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  1101001434 , 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)





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