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General NPI Number Information
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NPI Number | 1477842763
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Entity Type | Organization
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Legal Business Name | CHARLES B TWIGG
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 33 W MAIN ST
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City | BERRYVILLE
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State | VA
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Zip | 22611-1340
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Country | US
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Telephone | 540-955-5051
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Fax | 540-955-5052
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Provider Business Mailing Address
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Address Line | 33 W MAIN ST
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City | BERRYVILLE
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State | VA
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Zip | 22611-1340
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Country | US
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Telephone | 540-955-5051
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Fax | 540-955-5052
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES BAYLISS TWIGG
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Credential | O.D.
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Telephone | 540-955-5051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 0618000137
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618000137
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License Number State | VA
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