NPIMap

Organization Active NPI

Blue Ridge Optical

  • Eyewear Supplier
  • Roanoke, VA
National Provider Identifier
1639192594
Registry record updated Jun 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 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
Last updated
Jun 15, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
BLUE RIDGE OPTICAL, INC.As 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
Christopher M Clark, VA, LICENSEDOPTICIANNPI 1801063664
Title
Manager
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 VA Primary

Addresses

Primary practice location

1960 Electric Rd
Roanoke, VA 24018-1621

Mailing address

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

National Provider Directory

National Provider Directory
Part of
Blue Ridge Optical

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 2

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": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434326400000",
    "number": "1639192594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 ELECTRIC RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240181621",
            "telephone_number": "540-776-9722",
            "fax_number": "504-776-5119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 ELECTRIC RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240181621",
            "telephone_number": "540-776-9722",
            "fax_number": "504-776-5119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE OPTICAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLUE RIDGE OPTICAL, INC.",
        "enumeration_date": "2006-07-25",
        "last_updated": "2015-06-15",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "540-776-9722",
        "authorized_official_credential": "VA, LICENSEDOPTICIAN"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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.