| Organization Name: | BLUE RIDGE OPTICAL |
| NPI Number: | 1063689834 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTOPHER CLARK (MANAGER/LICENSED OPTICIAN) |
| Mailing Address: | 33 British Woods Dr 1960 Electric Road Roanoke |
| State: | VA US |
| Postal Code: | 240198267 |
| Phone Number: | 5409926797 |
| Fax Number: | |
| NPI Enumeration Date: | 05/12/2008 |
| NPI Last Update Date: | 06/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332H00000X |
| License Number: | 1101 000964 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |