Healthcare Provider Details

I. General information

NPI: 1821270539
Provider Name (Legal Business Name): KERRY CLINE & ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 SHORT ST
POUNDING MILL VA
24637-4189
US

IV. Provider business mailing address

113 SHORT ST
POUNDING MILL VA
24637-4189
US

V. Phone/Fax

Practice location:
  • Phone: 276-963-7400
  • Fax: 276-963-8778
Mailing address:
  • Phone: 276-963-7400
  • Fax: 276-963-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000966
License Number StateVA

VIII. Authorized Official

Name: DR. KERRY KEITH CLINE
Title or Position: OPTOMETRIST/PRESIDENT
Credential: OD
Phone: 276-963-7400