Provider Demographics
NPI:1689637670
Name:DUDLEY OPTICAL CO INC
Entity Type:Organization
Organization Name:DUDLEY OPTICAL CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WARRIS
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNAO
Authorized Official - Phone:804-343-7211
Mailing Address - Street 1:418 NORTH 1ST ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-1702
Mailing Address - Country:US
Mailing Address - Phone:804-343-7211
Mailing Address - Fax:804-648-2095
Practice Address - Street 1:418 NORTH 1ST ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1702
Practice Address - Country:US
Practice Address - Phone:804-343-7211
Practice Address - Fax:804-648-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA465156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9280570Medicaid
VA9280570Medicaid