Healthcare Provider Details

I. General information

NPI: 1124052980
Provider Name (Legal Business Name): RICK L NORTON OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 WISE CO PLAZA
WISE VA
24293
US

IV. Provider business mailing address

PO BOX 3100
WISE VA
24293-3100
US

V. Phone/Fax

Practice location:
  • Phone: 276-679-5610
  • Fax:
Mailing address:
  • Phone: 276-679-5610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1101001242
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: