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General NPI Number Information
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NPI Number | 1922060979
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Entity Type | Organization
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Legal Business Name | DAVID A GLADWELL OD INC
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 412 N BRIDGE ST
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City | BEDFORD
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State | VA
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Zip | 24523-0238
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Country | US
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Telephone | 540-586-9575
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Fax | 540-586-0129
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Provider Business Mailing Address
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Address Line | 412 N BRIDGE ST
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City | BEDFORD
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State | VA
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Zip | 24523-0238
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Country | US
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Telephone | 540-586-9575
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Fax | 540-586-0129
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Authorized Official
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Title or Position | SECRETARY RECEPTIONIST
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Name | MRS. CYNTHIA PORTER MAYHEW
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Credential |
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Telephone | 540-586-9575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0601000565
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License Number State | VA
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