Provider Demographics
NPI:1982863684
Name:NATIONAL OPTICAL
Entity Type:Organization
Organization Name:NATIONAL OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:540-776-2933
Mailing Address - Street 1:4135 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-5703
Mailing Address - Country:US
Mailing Address - Phone:540-776-2933
Mailing Address - Fax:540-776-2932
Practice Address - Street 1:4135 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-5703
Practice Address - Country:US
Practice Address - Phone:540-776-2933
Practice Address - Fax:540-776-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1434156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009280529Medicaid
VAVA1425OtherEYE MED
VA05098OtherSPECTERA
VA079880OtherANTHEM
VA5678OtherDAVIS VISION
VA05098OtherSPECTERA