Provider Demographics
NPI:1407926850
Name:DRS. LAW AND GONZALEZ
Entity Type:Organization
Organization Name:DRS. LAW AND GONZALEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-694-7126
Mailing Address - Street 1:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-0969
Mailing Address - Country:US
Mailing Address - Phone:276-694-7126
Mailing Address - Fax:276-694-7449
Practice Address - Street 1:797 WOODLAND DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171
Practice Address - Country:US
Practice Address - Phone:276-694-7126
Practice Address - Fax:276-694-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000924152W00000X
VA0618000179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902643Medicaid
NC5902643Medicaid
VA410001210Medicare PIN
VA410001211Medicare PIN
VAU24538Medicare UPIN
VAU79176Medicare UPIN
VAC06690Medicare PIN