Provider Demographics
NPI:1093908410
Name:GOTTSCHALK, ROY EDWARD
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:EDWARD
Last Name:GOTTSCHALK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WEEMS LN
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3602
Mailing Address - Country:US
Mailing Address - Phone:540-662-2444
Mailing Address - Fax:
Practice Address - Street 1:40 WEEMS LN
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3602
Practice Address - Country:US
Practice Address - Phone:540-662-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101000841156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician