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General NPI Number Information
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NPI Number | 1245433705
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Entity Type | Organization
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Legal Business Name | BETSY A ROSE
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 329 CUMMINGS ST
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City | ABINGDON
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State | VA
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Zip | 24210-3207
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Country | US
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Telephone | 276-628-9970
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Fax | 276-628-9937
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Provider Business Mailing Address
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Address Line | 329 CUMMINGS ST
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City | ABINGDON
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State | VA
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Zip | 24210-3207
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Country | US
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Telephone | 276-628-9970
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Fax | 276-628-9937
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Authorized Official
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Title or Position | OFFICE MANAGER/OWNER
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Name | MS. BETSY A. ROSE
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Credential |
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Telephone | 276-628-9970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1101001369
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License Number State | VA
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