Provider Demographics
NPI:1881956142
Name:MCCULLEY, AMBER HURLEY (OD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:HURLEY
Last Name:MCCULLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:284 BEN BOLT AVE
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-5384
Mailing Address - Country:US
Mailing Address - Phone:276-202-0616
Mailing Address - Fax:276-385-1939
Practice Address - Street 1:284 BEN BOLT AVE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-5384
Practice Address - Country:US
Practice Address - Phone:276-385-1940
Practice Address - Fax:276-385-1939
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002147152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist