Healthcare Provider Details

I. General information

NPI: 1518033703
Provider Name (Legal Business Name): PRECISION OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5453 GOVERNOR GC PEERY HWY DORAN PROFESSIONAL BLDG
DORAN VA
24612
US

IV. Provider business mailing address

PO BOX 9
DORAN VA
24612
US

V. Phone/Fax

Practice location:
  • Phone: 276-963-1030
  • Fax: 276-963-5225
Mailing address:
  • Phone: 276-963-1030
  • Fax: 276-963-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. KENNETH EDWARD ANSELMI
Title or Position: OWNER
Credential: MD
Phone: 276-963-1030