Organization
BLUE RIDGE OPTICAL
Active
Parent organization
BLUE RIDGE OPTICAL, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLUE RIDGE OPTICAL, INC.
Authorized official
CHRISTOPHER M CLARK VA, LICENSEDOPTICIAN (MANAGER)
(540) 776-9722
Entity
Organization
Contact information
Practice address
1960 ELECTRIC RD, ROANOKE, VA 24018-1621
(540) 776-9722
(504) 776-5119
Mailing address
1960 ELECTRIC RD, ROANOKE, VA 24018-1621
(540) 776-9722
(504) 776-5119
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
452898
ANTHEM
VA
05
—
92-8062-6
—
VA
Enumeration date
07/25/2006
Last updated
06/15/2015
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