Provider Demographics
NPI:1235496019
Name:APPALACHIAN COLLEGE OF OPTOMETRY
Entity Type:Organization
Organization Name:APPALACHIAN COLLEGE OF OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:LOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:276-244-0171
Mailing Address - Street 1:1193 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-6780
Mailing Address - Country:US
Mailing Address - Phone:276-244-0171
Mailing Address - Fax:
Practice Address - Street 1:1193 PLAZA DR
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-6780
Practice Address - Country:US
Practice Address - Phone:276-244-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000677152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty