Provider Demographics
NPI:1699703272
Name:MCBRIDE BLACKBURN OPTICIANS
Entity type:Organization
Organization Name:MCBRIDE BLACKBURN OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-239-3673
Mailing Address - Street 1:5525 FORT AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5317
Mailing Address - Country:US
Mailing Address - Phone:434-239-3673
Mailing Address - Fax:
Practice Address - Street 1:5525 FORT AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5317
Practice Address - Country:US
Practice Address - Phone:434-239-3673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9281339Medicaid
VA0571830001Medicare ID - Type UnspecifiedOPTICIAL GOODS