Healthcare Provider Details

I. General information

NPI: 1164561908
Provider Name (Legal Business Name): DOUGLAS R. WEBERLING O.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 EUCLID AVE SUITE D
BRISTOL VA
24201-3700
US

IV. Provider business mailing address

1701 EUCLID AVE SUITE D
BRISTOL VA
24201-3700
US

V. Phone/Fax

Practice location:
  • Phone: 276-466-4227
  • Fax:
Mailing address:
  • Phone: 276-466-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000247
License Number StateVA

VIII. Authorized Official

Name: DOUGLAS RICHARD WEBERLING
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 276-466-4227