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General NPI Number Information
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NPI Number | 1639279680
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Entity Type | Organization
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Legal Business Name | VIRGINIA OPTICAL CENTER INC
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 1980 S SYCAMORE ST
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City | PETERSBURG
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State | VA
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Zip | 23805-2729
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Country | US
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Telephone | 804-861-3005
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Fax | 804-861-8243
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Provider Business Mailing Address
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Address Line | 1980 S SYCAMORE ST
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City | PETERSBURG
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State | VA
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Zip | 23805-2729
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Country | US
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Telephone | 804-861-3005
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Fax | 804-861-8243
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Authorized Official
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Title or Position | OPTICIAN OWNER
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Name | MR. DOUGLAS POWELL FISHER JR.
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Credential | OPTICIAN
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Telephone | 804-861-3005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1101001155
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License Number State | VA
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