Organization Name: | BLUE RIDGE OPTICAL |
NPI Number: | 1508898057 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KRISTEN JANA CALHOUN (LIC. OPTICIAN) |
Mailing Address: | 13295 Booker T Washington Hwy Hardy |
State: | VA US |
Postal Code: | 241013947 |
Phone Number: | 5407217200 |
Fax Number: | |
NPI Enumeration Date: | 07/07/2006 |
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 001548 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |