Provider Demographics
NPI:1245502913
Name:ROANOKE VALLEY CENTER FOR SIGHT, LLC
Entity type:Organization
Organization Name:ROANOKE VALLEY CENTER FOR SIGHT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACI
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:RUNYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-855-5139
Mailing Address - Street 1:PO BOX 1789
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24008-1789
Mailing Address - Country:US
Mailing Address - Phone:540-855-5139
Mailing Address - Fax:540-342-4373
Practice Address - Street 1:438 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-3610
Practice Address - Country:US
Practice Address - Phone:540-378-5276
Practice Address - Fax:540-342-4373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROANOKE VALLEY CENTER FOR SIGHT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-27
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAOH667261QA1903X
367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09193Medicare PIN