Provider Demographics
NPI:1235377177
Name:BLUE RIDGE EYE SPECIALISTS PC
Entity Type:Organization
Organization Name:BLUE RIDGE EYE SPECIALISTS PC
Other - Org Name:THE OPTICAL SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-662-2700
Mailing Address - Street 1:420 W JUBAL EARLY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-662-2700
Mailing Address - Fax:540-662-8801
Practice Address - Street 1:420 W JUBAL EARLY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6434
Practice Address - Country:US
Practice Address - Phone:540-662-2700
Practice Address - Fax:540-662-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1163430002Medicare NSC