MEDICARE: DUDLEY OPTICAL CO INC

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	465	VA

Other Identifiers

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

General Provider Information

NPI Number	:	1689637670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUDLEY OPTICAL CO INC

Provider Business Mailing Address
First Line	:	418 NORTH 1ST ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23219-1702
Country	:	US
Telephone Number	:	804-343-7211
Fax Number	:	804-648-2095

Provider Business Practice Location Address
First Line	:	418 NORTH 1ST ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23219-1702
Country	:	US
Telephone Number	:	804-343-7211
Fax Number	:	804-648-2095

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WARRIS DARNELL DUDLEY
Credential	:	FNAO
Telephone Number	:	804-343-7211

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	08/22/2020

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