Provider Demographics
NPI:1063513471
Name:ABINGDON OPTICIANS LTD
Entity type:Organization
Organization Name:ABINGDON OPTICIANS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:POTTER
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:276-628-9943
Mailing Address - Street 1:276 W MAIN ST
Mailing Address - Street 2:PO BIX 713
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2749
Mailing Address - Country:US
Mailing Address - Phone:276-628-9943
Mailing Address - Fax:276-623-1232
Practice Address - Street 1:276 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2749
Practice Address - Country:US
Practice Address - Phone:276-628-9943
Practice Address - Fax:276-623-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001373156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5877220001Medicare NSC