Provider Demographics
NPI:1407823438
Name:NATIONAL OPTICAL
Entity Type:Organization
Organization Name:NATIONAL OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:540-362-0300
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:540-362-0300
Mailing Address - Fax:540-362-5574
Practice Address - Street 1:300 W VIRGINIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-3212
Practice Address - Country:US
Practice Address - Phone:540-343-4252
Practice Address - Fax:540-343-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001434156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0259990002Medicare ID - Type Unspecified