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General NPI Number Information
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NPI Number | 1982705448
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Entity Type | Organization
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Legal Business Name | WALLY BETTON OD LLC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 4244 VIRGINIA AVE
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City | COLLINSVILLE
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State | VA
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Zip | 24078-1935
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Country | US
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Telephone | 276-647-3766
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Fax | 276-647-4279
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Provider Business Mailing Address
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Address Line | 4244 VIRGINIA AVE
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City | COLLINSVILLE
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State | VA
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Zip | 24078-1935
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Country | US
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Telephone | 276-647-3766
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Fax | 276-647-4279
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Authorized Official
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Title or Position | OWNER
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Name | WALLY BETTON
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Credential | O.D.
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Telephone | 276-647-3766
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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 | 0618000209
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License Number State | VA
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