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General NPI Number Information
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NPI Number | 1679177893
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE EYE ASSOCIATES OF ROCKBRIDGE COUNTY LLC
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Dates
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Enumeration Date | 11/29/2020
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Last Update Date | 11/29/2020
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Provider Practice Location Address
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Address Line | 30 CROSSING LN STE 107
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City | LEXINGTON
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State | VA
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Zip | 24450-6354
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Country | US
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Telephone | 847-275-9404
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Fax | 540-463-1722
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Provider Business Mailing Address
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Address Line | 30 CROSSING LN STE 107
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City | LEXINGTON
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State | VA
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Zip | 24450-6354
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Country | US
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Telephone | 847-275-9404
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Fax | 540-463-1722
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. LINDSAY MARIE PETRIE
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Credential | OD
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Telephone | 847-275-9404
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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 |
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License Number State |
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