Healthcare Provider Details

I. General information

NPI: 1477842763
Provider Name (Legal Business Name): CHARLES B TWIGG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W MAIN ST
BERRYVILLE VA
22611-1340
US

IV. Provider business mailing address

33 W MAIN ST
BERRYVILLE VA
22611-1340
US

V. Phone/Fax

Practice location:
  • Phone: 540-955-5051
  • Fax: 540-955-5052
Mailing address:
  • Phone: 540-955-5051
  • Fax: 540-955-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000137
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number0618000137
License Number StateVA

VIII. Authorized Official

Name: DR. CHARLES BAYLISS TWIGG
Title or Position: OWNER
Credential: O.D.
Phone: 540-955-5051