Blue Ridge Optical

Organization Active NPI Eyewear Supplier · Roanoke, VA

NPI 1639192594 · NPPES record last updated Jun 15, 2015

Key facts

NPI
1639192594
Entity type
Organization (NPI type 2)
Primary specialty
Eyewear Supplier 332H00000X
Legal business name
BLUE RIDGE OPTICAL
Practice address
1960 Electric Rd
Roanoke, VA 24018-1621
Phone
(540) 776-9722
Fax
(504) 776-5119
NPI assigned
Jul 25, 2006
Organization subpart
Yes
Parent organization (as reported)
BLUE RIDGE OPTICAL, INC.

Authorized official

Name
Christopher M Clark, VA, LICENSEDOPTICIAN
Title
Manager
Phone
(540) 776-9722

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 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Part of
Blue Ridge Optical

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X VA Yes

Addresses

Primary practice location

1960 Electric Rd
Roanoke, VA 24018-1621

Mailing address

1960 Electric Rd
Roanoke, VA 24018-1621
Phone (540) 776-9722

Other identifiers

IdentifierTypeStateIssuer
452898OtherVAANTHEM
92-8062-6MedicaidVA

Other providers in Roanoke, VA

All providers in Roanoke, VA · Eyewear Supplier in Virginia

Sources for this page

Verify at the official NPI Registry.