Provider Demographics
NPI:1437462843
Name:MARTINSVILLE OPTICAL CO., INC.
Entity Type:Organization
Organization Name:MARTINSVILLE OPTICAL CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:276-632-8293
Mailing Address - Street 1:P.O BOX 4748
Mailing Address - Street 2:749 B. EAST CHURCH STREET
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24115
Mailing Address - Country:US
Mailing Address - Phone:276-632-5401
Mailing Address - Fax:276-632-0052
Practice Address - Street 1:749 B. EAST CHURCH STREET
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24115
Practice Address - Country:US
Practice Address - Phone:276-632-5401
Practice Address - Fax:276-632-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101000447156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty