Healthcare Provider Details

I. General information

NPI: 1013296581
Provider Name (Legal Business Name): REPKO FAMILY VISION CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 GATEWAY PLZ SUITE 106
GATE CITY VA
24251-3350
US

IV. Provider business mailing address

241 GATEWAY PLZ SUITE 106
GATE CITY VA
24251-3350
US

V. Phone/Fax

Practice location:
  • Phone: 276-690-2345
  • Fax:
Mailing address:
  • Phone: 276-690-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MELISSA G REPKO
Title or Position: MEMBER
Credential: OD
Phone: 276-690-2345