Provider Demographics
NPI:1881750719
Name:COX, TAMMY R
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:R
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 HERSHBERGER RD NW
Mailing Address - Street 2:UNIT C
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-7319
Mailing Address - Country:US
Mailing Address - Phone:540-362-0300
Mailing Address - Fax:540-362-5574
Practice Address - Street 1:1507 HERSHBERGER RD NW
Practice Address - Street 2:UNIT C
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-7319
Practice Address - Country:US
Practice Address - Phone:540-362-0300
Practice Address - Fax:540-362-5574
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001638156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA284114OtherANTHEM