Provider Demographics
NPI:1285819151
Name:ETTER ENTERPRISES INC
Entity Type:Organization
Organization Name:ETTER ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:N
Authorized Official - Last Name:ETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-342-1796
Mailing Address - Street 1:2122 COLONIAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-3205
Mailing Address - Country:US
Mailing Address - Phone:540-342-1796
Mailing Address - Fax:
Practice Address - Street 1:2122 COLONIAL AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-3205
Practice Address - Country:US
Practice Address - Phone:540-342-1796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101000741332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0130560001Medicare NSC