Healthcare Provider Details

I. General information

NPI: 1144479353
Provider Name (Legal Business Name): NEW VISION OPTICAL -WISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 WISE COUNTY 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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1101001242
License Number StateVA

VIII. Authorized Official

Name: RICK NORTON
Title or Position: OPTICIAN
Credential:
Phone: 276-679-5610