=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679553895
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISION RADIOLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2006
-----------------------------------------------------
Last Update Date | 10/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2949 WEST FRONT STREET
-----------------------------------------------------
City | RICHLANDS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-596-6137
-----------------------------------------------------
Fax | 276-596-5143
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1647
-----------------------------------------------------
City | RICHLANDS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24641-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EDSON L KNAPP
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 276-596-6137
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------