NPIMap

Organization Active NPI

Blue Ridge Optical

  • Eyewear Supplier
  • Roanoke, VA
National Provider Identifier
1063689834
Registry record updated Jun 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
1101 000964 Issued in VA
Legal business name
BLUE RIDGE OPTICAL
Practice address
33 British Woods Dr
1960 Electric Road
Roanoke, VA 24019-8267
Phone
(540) 992-6797
NPI assigned
May 12, 2008
Last updated
Jun 15, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
BLUE RIDGE OPTICALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 15, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Christopher ClarkNPI 1801063664
Title
Manager/Licensed Optician
Phone
(540) 776-9722

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X 1101 000964 VA Primary

Addresses

Primary practice location

33 British Woods Dr
1960 Electric Road
Roanoke, VA 24019-8267

Mailing address

33 British Woods Dr
1960 Electric Road
Roanoke, VA 24019-8267
Phone (540) 992-6797

Other identifiers 1

IdentifierTypeStateIssuer
OP2378OtherVAEYEMED VISION CARE

National Provider Directory

National Provider Directory
Tax ID family
Blue Ridge Optical4 organizations share this tax ID, including this one
Part of
Blue Ridge Optical

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434326400000",
    "number": "1063689834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 BRITISH WOODS DR",
            "address_2": "1960 ELECTRIC ROAD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240198267",
            "telephone_number": "540-992-6797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 BRITISH WOODS DR",
            "address_2": "1960 ELECTRIC ROAD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240198267",
            "telephone_number": "540-992-6797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE OPTICAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLUE RIDGE OPTICAL",
        "enumeration_date": "2008-05-12",
        "last_updated": "2015-06-15",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGER/LICENSED OPTICIAN",
        "authorized_official_telephone_number": "540-776-9722",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "VA",
            "license": "1101 000964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED VISION CARE",
            "identifier": "OP2378",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.