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General NPI Number Information
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NPI Number | 1851441398
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Entity Type | Individual
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Provider Name | LYNN CARLTON VIA OPTICIAN
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3555-A ELECTRIC RD
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City | ROANOKE
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State | VA
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Zip | 24018
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Country | US
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Telephone | 540-989-5036
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Fax | 540-989-1353
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Provider Business Mailing Address
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Address Line | 2513 MOUNT VERNON RD SW
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City | ROANOKE
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State | VA
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Zip | 24015-3619
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Country | US
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Telephone | 540-344-9922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1101 001046
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License Number State | VA
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