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General NPI Number Information
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NPI Number | 1801986765
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Entity Type | Organization
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Legal Business Name | ASHMORE OPTICAL COMPANY, INC.
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1021 QUARRIER ST
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City | CHARLESTON
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State | WV
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Zip | 25301-2338
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Country | US
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Telephone | 304-344-2366
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Fax | 304-344-2369
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Provider Business Mailing Address
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Address Line | 1021 QUARRIER ST
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City | CHARLESTON
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State | WV
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Zip | 25301-2338
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Country | US
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Telephone | 304-344-2366
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Fax | 304-344-2369
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAUL ASHLAND BURDETTE III
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Credential |
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Telephone | 304-344-2366
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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 | S-1998
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License Number State | OH
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