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General NPI Number Information
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NPI Number | 1497293542
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Entity Type | Organization
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Legal Business Name | MORRIS OPTICAL INC
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 521 WEBSTER ST
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-2429
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Country | US
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Telephone | 434-572-9500
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Fax | 434-575-1333
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Provider Business Mailing Address
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Address Line | 521 WEBSTER ST
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-2429
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Country | US
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Telephone | 434-572-9500
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Fax | 434-575-1333
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Authorized Official
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Title or Position | OWNER PROVIDER
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Name | DR. MARK J MORRIS
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Credential | MD
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Telephone | 434-572-9500
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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 |
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License Number State |
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