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General NPI Number Information
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NPI Number | 1689836512
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Entity Type | Organization
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Legal Business Name | BOOTHE FAMILY VISION CARE
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 4524 CHALLENGER AVE
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City | ROANOKE
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State | VA
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Zip | 24012-7028
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Country | US
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Telephone | 540-977-2380
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Fax | 540-977-2382
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Provider Business Mailing Address
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Address Line | 100 KIMBALL AVE #E56
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City | SALEM
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State | VA
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Zip | 24153-6735
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Country | US
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Telephone | 540-389-3924
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. KARI HARNER BOOTHE
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Credential | O.D.
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Telephone | 540-389-3924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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