Provider Demographics
NPI:1710429592
Name:WIMMER OPTICAL
Entity Type:Organization
Organization Name:WIMMER OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:276-403-4678
Mailing Address - Street 1:730 E CHURCH ST STE 22
Mailing Address - Street 2:P.O BOX 4629
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3151
Mailing Address - Country:US
Mailing Address - Phone:276-403-4678
Mailing Address - Fax:276-403-4679
Practice Address - Street 1:730 E CHURCH ST STE 22
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3151
Practice Address - Country:US
Practice Address - Phone:276-403-4678
Practice Address - Fax:276-403-4679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA8410332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier