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General NPI Number Information
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NPI Number | 1215101126
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Entity Type | Organization
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Legal Business Name | DRS. GARDNER & VELOSO
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 307 1ST ST SW
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City | ROANOKE
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State | VA
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Zip | 24011-1901
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Country | US
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Telephone | 540-342-6294
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Fax | 540-342-8201
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Provider Business Mailing Address
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Address Line | 307 1ST ST SW
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City | ROANOKE
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State | VA
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Zip | 24011-1901
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Country | US
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Telephone | 540-342-6294
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Fax | 540-342-8201
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. ASHLEY C. VELOSO
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Credential | OD
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Telephone | 540-342-6294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 0618001002
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 0618001002
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License Number State | VA
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