Healthcare Provider Details

I. General information

NPI: 1053421552
Provider Name (Legal Business Name): ODETTE CALLENDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEMORIAL DR STE A
DANVILLE VA
24541-1680
US

IV. Provider business mailing address

PO BOX 1290
FOREST VA
24551-1290
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-3232
  • Fax:
Mailing address:
  • Phone: 434-385-5600
  • Fax: 434-455-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101043505
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: