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General NPI Number Information
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NPI Number | 1306040910
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Entity Type | Individual
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Provider Name | STANLEY HORTON BOTTS JR. O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 780 COMMONWEALTH DR OPTOMETRIST SUITE
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City | NORTON
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State | VA
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Zip | 24273-4051
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Country | US
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Telephone | 276-870-7712
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Fax |
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Provider Business Mailing Address
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Address Line | 122 WYANDOTTE AVE E
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City | BIG STONE GAP
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State | VA
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Zip | 24219-2934
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Country | US
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Telephone | 276-523-2319
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Fax | 276-523-2319
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0618000017
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License Number State | VA
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