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General NPI Number Information
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NPI Number | 1578617569
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Entity Type | Organization
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Legal Business Name | NEW OPTICIANS BOUTIQUE
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 203 N MAIN ST
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City | LEXINGTON
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State | VA
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Zip | 24450-2650
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Country | US
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Telephone | 540-463-7440
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Fax | 540-464-1888
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Provider Business Mailing Address
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Address Line | 203 N MAIN ST
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City | LEXINGTON
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State | VA
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Zip | 24450-2650
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Country | US
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Telephone | 540-463-7440
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Fax | 540-464-1888
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Authorized Official
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Title or Position | LICENSED OPTICIAN
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Name | MRS. ALANDA KAY TOMLIN
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Credential |
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Telephone | 540-463-7440
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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 | 002622
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License Number State | VA
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