Wally Betton OD LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618000209 Issued in VA

Legal business name

WALLY BETTON OD LLC

Practice address

4244 Virginia Ave
Collinsville, VA 24078-1935

Phone

(276) 647-3766

Fax

(276) 647-4279

NPI assigned

Sep 26, 2006

Organization subpart

No

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

Authorized official

Name

Wally Betton, O.D.

Title

Owner

Phone

(276) 647-3766

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340928000000",
    "number": "1982705448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4244 VIRGINIA AVE",
            "city": "COLLINSVILLE",
            "state": "VA",
            "postal_code": "240781935",
            "telephone_number": "276-647-3766",
            "fax_number": "276-647-4279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4244 VIRGINIA AVE",
            "city": "COLLINSVILLE",
            "state": "VA",
            "postal_code": "240781935",
            "telephone_number": "276-647-3766",
            "fax_number": "276-647-4279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLY BETTON OD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2012-06-29",
        "status": "A",
        "authorized_official_last_name": "BETTON",
        "authorized_official_first_name": "WALLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "276-647-3766",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010332770",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010337399",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010145660",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; 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.