Healthcare Provider Details

I. General information

NPI: 1134506983
Provider Name (Legal Business Name): ONE WORLD OPTICAL BUSINESS L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105A TRADEWYND DR SUITE 3
LYNCHBURG VA
24502-3112
US

IV. Provider business mailing address

1076 GABLES DR APT 207
FOREST VA
24551-4755
US

V. Phone/Fax

Practice location:
  • Phone: 434-382-8207
  • Fax: 434-266-0078
Mailing address:
  • Phone: 434-382-8207
  • Fax: 434-266-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1101003537
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1101003537
License Number StateVA

VIII. Authorized Official

Name: MR. MARTIN SHAHMIRZADI
Title or Position: ABOC/LICENSED OPTICIAN/OWNER
Credential:
Phone: 434-382-8207