Provider Demographics
NPI:1689836512
Name:BOOTHE FAMILY VISION CARE
Entity Type:Organization
Organization Name:BOOTHE FAMILY VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:HARNER
Authorized Official - Last Name:BOOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-389-3924
Mailing Address - Street 1:100 KIMBALL AVE
Mailing Address - Street 2:#E56
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6735
Mailing Address - Country:US
Mailing Address - Phone:540-389-3924
Mailing Address - Fax:
Practice Address - Street 1:4524 CHALLENGER AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-7028
Practice Address - Country:US
Practice Address - Phone:540-977-2380
Practice Address - Fax:540-977-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center