Provider Demographics
NPI:1083645097
Name:RECTOR, MARY MARGARET (RO)
Entity Type:Individual
Prefix:
First Name:MARY MARGARET
Middle Name:
Last Name:RECTOR
Suffix:
Gender:F
Credentials:RO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 E STUART DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2231
Mailing Address - Country:US
Mailing Address - Phone:276-236-4066
Mailing Address - Fax:
Practice Address - Street 1:544 E STUART DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2231
Practice Address - Country:US
Practice Address - Phone:276-236-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001399156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0429880001Medicare ID - Type UnspecifiedPROVIDER NUMBER