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General NPI Number Information
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NPI Number | 1689637670
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Entity Type | Organization
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Legal Business Name | DUDLEY OPTICAL CO INC
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 418 NORTH 1ST ST
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City | RICHMOND
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State | VA
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Zip | 23219-1702
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Country | US
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Telephone | 804-343-7211
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Fax | 804-648-2095
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Provider Business Mailing Address
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Address Line | 418 NORTH 1ST ST
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City | RICHMOND
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State | VA
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Zip | 23219-1702
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Country | US
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Telephone | 804-343-7211
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Fax | 804-648-2095
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WARRIS DARNELL DUDLEY
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Credential | FNAO
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Telephone | 804-343-7211
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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 | 465
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License Number State | VA
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