Healthcare Provider Details

I. General information

NPI: 1124198122
Provider Name (Legal Business Name): NRV EYE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S FRANKLIN ST STE C
CHRISTIANSBURG VA
24073-3547
US

IV. Provider business mailing address

106 S FRANKLIN ST STE C
CHRISTIANSBURG VA
24073-3547
US

V. Phone/Fax

Practice location:
  • Phone: 540-381-2013
  • Fax:
Mailing address:
  • Phone: 540-381-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101058838
License Number StateVA

VIII. Authorized Official

Name: TEDD R PUCKETT
Title or Position: PRESIDENT
Credential: MD
Phone: 540-381-2013