Provider Demographics
NPI:1306901772
Name:CHURCH, DEBORAH WITT (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:WITT
Last Name:CHURCH
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WITTS LN
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:VA
Mailing Address - Zip Code:24055-8013
Mailing Address - Country:US
Mailing Address - Phone:276-629-5588
Mailing Address - Fax:276-638-1859
Practice Address - Street 1:240 COMMONWEALTH BLVD W
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1800
Practice Address - Country:US
Practice Address - Phone:276-638-4461
Practice Address - Fax:276-638-1859
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001459156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician