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NPI Code Detail

MEDICARE: RUTH AMBER MERCADO

MEDICARE:   RUTH AMBER MERCADO
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
1156FX1800XOptician1101004587VA

General Provider Information

NPI Number : 1134952690
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUTH AMBER MERCADO
Provider Business Mailing Address
First Line : 127 CANTERBURY RD
Second Line :
City : DANVILLE
State : VA
Zip : 24541-2663
Country : US
Telephone Number : 276-618-2294
Fax Number :
Provider Business Practice Location Address
First Line : 4244 VIRGINIA AVE
Second Line :
City : COLLINSVILLE
State : VA
Zip : 24078-1935
Country : US
Telephone Number : 276-647-3766
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2024
Last Update Date : 08/21/2024

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Directions to “ RUTH AMBER MERCADO ” Practice Location

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