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General NPI Number Information
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NPI Number | 1184679052
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Entity Type | Organization
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Legal Business Name | NATIONAL OPTOMETRIC CENTER PLC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 1507 HERSHBERGER RD NW UNIT C
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City | ROANOKE
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State | VA
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Zip | 24012-7319
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Country | US
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Telephone | 540-362-1030
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Fax | 540-362-5574
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Provider Business Mailing Address
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Address Line | 1507 HERSHBERGER RD NW UNIT C
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City | ROANOKE
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State | VA
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Zip | 24012-7319
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Country | US
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Telephone | 540-362-1030
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Fax | 540-362-5574
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Authorized Official
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Title or Position | MANAGER / OPTICIAN
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Name | TAMMY R COX
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Credential | LDO
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Telephone | 540-362-1030
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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 | 0618000577
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License Number State | VA
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