MEDICARE: MR. TIMOTHY LEE ADKINS OPTICIAN

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	1101003326	VA

General Provider Information

NPI Number	:	1881021426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY LEE ADKINS OPTICIAN

Provider Business Mailing Address
First Line	:	767 VILLAGE HWY
Second Line	:
City	:	RUSTBURG
State	:	VA
Zip	:	24588-4442
Country	:	US
Telephone Number	:	434-266-1240
Fax Number	:	434-266-1244

Provider Business Practice Location Address
First Line	:	767 VILLAGE HWY
Second Line	:
City	:	RUSTBURG
State	:	VA
Zip	:	24588-4442
Country	:	US
Telephone Number	:	434-266-1240
Fax Number	:	434-266-1244

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

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	09/27/2013

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