Provider Demographics
NPI:1477842763
Name:CHARLES B TWIGG
Entity Type:Organization
Organization Name:CHARLES B TWIGG
Other - Org Name:BERRYVILLE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BAYLISS
Authorized Official - Last Name:TWIGG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-955-5051
Mailing Address - Street 1:33 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22611-1340
Mailing Address - Country:US
Mailing Address - Phone:540-955-5051
Mailing Address - Fax:540-955-5052
Practice Address - Street 1:33 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-1340
Practice Address - Country:US
Practice Address - Phone:540-955-5051
Practice Address - Fax:540-955-5052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000137152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6502970001OtherDME NSC PTAN
VA9232397Medicaid
VA9232397Medicaid
VA6502970001OtherDME NSC PTAN