Healthcare Provider Details

I. General information

NPI: 1295884898
Provider Name (Legal Business Name): DR THOMAS E UNTERBRINK OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 DANIEL CREEK RD
COLLINSVILLE VA
24078-1370
US

IV. Provider business mailing address

2202 DANIEL CREEK RD
COLLINSVILLE VA
24078-1370
US

V. Phone/Fax

Practice location:
  • Phone: 276-647-3861
  • Fax: 276-647-4217
Mailing address:
  • Phone: 276-647-3861
  • Fax: 276-647-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000365
License Number StateVA

VIII. Authorized Official

Name: DR. THOMAS EDWARD UNTERBRINK
Title or Position: PRESIDENT
Credential: OD
Phone: 276-647-3861