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General NPI Number Information
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NPI Number | 1639581192
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Entity Type | Individual
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Provider Name | ROBERT ANDREW BOTTS OD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 606 POWELL AVE E
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City | BIG STONE GAP
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State | VA
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Zip | 24219-2348
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Country | US
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Telephone | 276-523-4414
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. DRAWER BB
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City | BIG STONE GAP
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State | VA
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Zip | 24219-0660
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Country | US
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Telephone | 273-523-4414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0618002327
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License Number State | VA
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