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NPI Code Detail

MEDICARE: BLUE RIDGE OPTICAL

MEDICARE: BLUE RIDGE OPTICAL
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
1332H00000XEyewear SupplierVA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1452898OTHERVAANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639192594
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE RIDGE OPTICAL
Provider Business Mailing Address
First Line : 1960 ELECTRIC RD
Second Line :
City : ROANOKE
State : VA
Zip : 24018-1621
Country : US
Telephone Number : 540-776-9722
Fax Number : 504-776-5119
Provider Business Practice Location Address
First Line : 1960 ELECTRIC RD
Second Line :
City : ROANOKE
State : VA
Zip : 24018-1621
Country : US
Telephone Number : 540-776-9722
Fax Number : 504-776-5119
Authorized Official
Title or Position : MANAGER
Name : CHRISTOPHER M CLARK
Credential : VA, LICENSEDOPTICIAN
Telephone Number : 540-776-9722
Provider Enumeration Date : 07/25/2006
Last Update Date : 06/15/2015

Similar Medicare Providers

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1649277229 — DR. SHARI L COOLBAUGH OD
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1023015476 — DR. WILLIAM MCKINLEY THOMPSON MD
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1720085608 — MR. LEE THOMAS HELMS MD
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1508864109 — DR. CAREY WILLIAM ROBINSON M.D.
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Directions to “BLUE RIDGE OPTICAL ” Practice Location

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