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NPI Code Detail

MEDICARE: WASHINGTON VO OD

MEDICARE: WASHINGTON VO OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist10728TX

General Provider Information

NPI Number : 1235853268
Entity Type Code : Individual
Provider Name (Legal Business Name) : WASHINGTON VO OD
Provider Business Mailing Address
First Line : 1212 N HIGHWAY 377 STE 105
Second Line :
City : ROANOKE
State : TX
Zip : 76262-6916
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1212 N HIGHWAY 377
Second Line :
City : ROANOKE
State : TX
Zip : 76262-6916
Country : US
Telephone Number : 817-837-5891
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2022
Last Update Date : 06/02/2023

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Directions to “ WASHINGTON VO OD” Practice Location

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