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General NPI Number Information
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NPI Number | 1982803615
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Entity Type | Organization
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Legal Business Name | CARROLL W POOVEY JR OPTOMETRIST
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 2400 N FRANKLIN ST
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073-1088
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Country | US
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Telephone | 540-381-3366
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Fax | 540-381-2007
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Provider Business Mailing Address
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Address Line | PO BOX 648
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City | CHRISTIANSBURG
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State | VA
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Zip | 24068-0648
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Country | US
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Telephone | 540-381-3366
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Fax | 540-381-2007
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARROLL WILBURN POOVEY JR.
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Credential | O.D.
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Telephone | 540-381-3366
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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 | 0618000105
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License Number State | VA
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