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General NPI Number Information
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NPI Number | 1619068640
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Entity Type | Organization
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Legal Business Name | EYE CARE CHRISTIANSBURG INC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 29 W MAIN ST
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073-2941
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Country | US
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Telephone | 540-381-2020
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Fax | 540-382-2660
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Provider Business Mailing Address
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Address Line | 29 W MAIN ST
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073-2941
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Country | US
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Telephone | 540-381-2020
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Fax | 540-382-2660
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIAM SCOTT MANN
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Credential | OD
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Telephone | 540-381-2020
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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 | 0601001355
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License Number State | VA
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