Provider Demographics
NPI:1073795068
Name:DRS. BOTTS & BOTTS, OPTOMETRISTS PC
Entity Type:Organization
Organization Name:DRS. BOTTS & BOTTS, OPTOMETRISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:276-523-4414
Mailing Address - Street 1:PO DRAWER BB
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-0660
Mailing Address - Country:US
Mailing Address - Phone:276-523-4414
Mailing Address - Fax:276-523-4414
Practice Address - Street 1:606 POWELL AVE E
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-2348
Practice Address - Country:US
Practice Address - Phone:276-523-4414
Practice Address - Fax:276-523-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACM8493OtherMEDICARE RR
VAC02472Medicare PIN
VAC02471Medicare PIN
VACM8493OtherMEDICARE RR