Doctor Name: | DAMON CANNADY |
NPI Number: | 1174649446 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | REGISTERED OPTICIAN |
License Number: | 1101 002127 |
Business Practice Address: | 621 Southpark Blvd Colonial Heights, VA - 238343617 |
Business Phone Number: | 8045204687 |
Business Fax Number: | 8045204688 |
Mailing Address: | 621 Southpark Blvd, COLONIAL HEIGHTS |
State: | VA |
Postal Code: | 238343617 |
Phone Number: | 8045204687 |
Fax Number: | 8045204688 |
NPI Enumeration Date: | 03/21/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 1101 002127 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |