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General NPI Number Information
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NPI Number | 1407360134
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Entity Type | Organization
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Legal Business Name | DANIEL KINGSLEY O.D., P.C.
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 100 N VIRGINIA ST
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City | FARMVILLE
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State | VA
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Zip | 23901-1537
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Country | US
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Telephone | 434-392-8113
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Fax | 434-392-6271
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Provider Business Mailing Address
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Address Line | 100 NORTH VIRGINIA ST P.O. BOX 303
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City | FARMVILLE
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State | VA
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Zip | 23901
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Country | US
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Telephone | 434-392-8113
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Fax | 434-392-6271
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. DANIEL KINGSLEY
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Credential | OD
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Telephone | 434-315-4036
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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 | 0618000544
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License Number State | VA
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