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General NPI Number Information
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NPI Number | 1033493275
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Entity Type | Organization
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Legal Business Name | O VICTOR WEATHERHOLT PC
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Dates
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Enumeration Date | 10/06/2011
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 1912 GRAVES MILL RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-4237
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Country | US
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Telephone | 434-385-7898
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Fax | 434-385-1421
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Provider Business Mailing Address
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Address Line | 1912 GRAVES MILL RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-4237
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Country | US
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Telephone | 434-385-7898
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Fax | 434-385-1421
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Authorized Official
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Title or Position | OWNER OF CORPORATION
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Name | DR. OTIS VICTOR WEATHERHOLT
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Credential | O.D.
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Telephone | 434-385-5318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618000350
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License Number State | VA
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