Provider Demographics
NPI:1184679052
Name:NATIONAL OPTOMETRIC CENTER PLC
Entity Type:Organization
Organization Name:NATIONAL OPTOMETRIC CENTER PLC
Other - Org Name:NATIONAL OPTOMETRIC CENTER PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER / OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:540-362-1030
Mailing Address - Street 1:1507 HERSHBERGER RD NW
Mailing Address - Street 2:UNIT C
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-7319
Mailing Address - Country:US
Mailing Address - Phone:540-362-1030
Mailing Address - Fax:540-362-5574
Practice Address - Street 1:1507 HERSHBERGER RD NW
Practice Address - Street 2:UNIT C
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-7319
Practice Address - Country:US
Practice Address - Phone:540-362-1030
Practice Address - Fax:540-362-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184679052Medicaid
VA009235787Medicaid
VA1184679052Medicaid
VA009235787Medicaid
VAC05881Medicare PIN
VACN8528Medicare PIN