Healthcare Provider Details

I. General information

NPI: 1003128505
Provider Name (Legal Business Name): AMBER COLLING O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 SUMMIT ST
BEDFORD VA
24523-2636
US

IV. Provider business mailing address

PO BOX 1290
FOREST VA
24551-1290
US

V. Phone/Fax

Practice location:
  • Phone: 434-385-5600
  • Fax:
Mailing address:
  • Phone: 434-385-5600
  • Fax: 434-455-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001966
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: