Organization
W. BERRY MAULTSBY, JR., O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALLACE BERRY MAULTSBY JR. O.D. (OPTOMETRIST)
(434) 791-3937
Entity
Organization
Contact information
Practice address
413 MT. CROSS ROAD, SUITE 203, DANVILLE, VA 24540
(434) 791-3937
(434) 791-2468
Mailing address
413 MT. CROSS ROAD, SUITE 203, DANVILLE, VA 24540
(434) 791-3937
(434) 791-2468
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000688
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010337861
—
VA
01
—
465270
ANTHEM
—
Enumeration date
05/26/2009
Last updated
06/02/2009
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