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General NPI Number Information
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NPI Number | 1215979935
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Entity Type | Organization
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Legal Business Name | DR GARY KLINK OPTOMETRIST PC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 550 OLD FRANKLIN TURNPIKE
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City | ROCKY MOUNT
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State | VA
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Zip | 24151-5504
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Country | US
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Telephone | 540-484-1164
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Fax | 540-484-1164
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Provider Business Mailing Address
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Address Line | 5612 BRAHMA RD
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City | ROANOKE
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State | VA
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Zip | 24018
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Country | US
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Telephone | 540-989-1389
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Fax |
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Authorized Official
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Title or Position | PRESIDENT DOCTOR OF OPTOMETRY
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Name | DR. GARY L KLINK
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Credential | OD
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Telephone | 540-989-1389
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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 | 0618000323
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License Number State | VA
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