Healthcare Provider Details

I. General information

NPI: 1073545539
Provider Name (Legal Business Name): EYECARE SALEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ROANOKE BLVD
SALEM VA
24153-4907
US

IV. Provider business mailing address

115 ROANOKE BLVD
SALEM VA
24153-4907
US

V. Phone/Fax

Practice location:
  • Phone: 540-387-1183
  • Fax:
Mailing address:
  • Phone: 540-387-1183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. TAMMY B CHITWOOD
Title or Position: INSURACE ADMINISTRATOR
Credential:
Phone: 540-387-1183