Provider Demographics
NPI:1346453966
Name:TRI-CITY OPTICIANS, LLC
Entity Type:Organization
Organization Name:TRI-CITY OPTICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-926-4234
Mailing Address - Street 1:5057 DICKENSON HWY
Mailing Address - Street 2:
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-6078
Mailing Address - Country:US
Mailing Address - Phone:276-926-4234
Mailing Address - Fax:276-926-4375
Practice Address - Street 1:5057 DICKENSON HWY
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-6078
Practice Address - Country:US
Practice Address - Phone:276-926-4234
Practice Address - Fax:276-926-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA003309156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5782420001Medicare NSC