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General NPI Number Information
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NPI Number | 1023005139
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Entity Type | Organization
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Legal Business Name | ROANOKE VALLEY CENTER FOR SIGHT LLC
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 438 W MAIN ST
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City | SALEM
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State | VA
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Zip | 24153-3610
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Country | US
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Telephone | 540-855-3554
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1789
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City | ROANOKE
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State | VA
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Zip | 24008-1789
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Country | US
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Telephone | 540-378-5276
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Fax |
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Authorized Official
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Title or Position | MANAGED CARE COORDINATOR
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Name | MRS. STACI E RUNYON
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Credential |
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Telephone | 540-855-3554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | OH667
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License Number State | VA
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