MEDICARE: MARY MARGARET RECTOR R.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	1101001399	VA

General Provider Information

NPI Number	:	1083645097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MARGARET RECTOR R.O.

Provider Business Mailing Address
First Line	:	544 E STUART DR
Second Line	:
City	:	GALAX
State	:	VA
Zip	:	24333-2231
Country	:	US
Telephone Number	:	276-236-4066
Fax Number	:

Provider Business Practice Location Address
First Line	:	544 E STUART DR
Second Line	:
City	:	GALAX
State	:	VA
Zip	:	24333-2231
Country	:	US
Telephone Number	:	276-236-4066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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