Organization
GORDON W. JENNINGS OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BILLIE L TAYLOR ABO, NCLC, CPOT (OFFICE MANAGER)
(276) 228-2771
Entity
Organization
Contact information
Practice address
310 E MAIN ST, WYTHEVILLE, VA 24382-2326
(276) 228-2771
(276) 228-9097
Mailing address
310 E MAIN ST, WYTHEVILLE, VA 24382-2326
(276) 228-2771
(276) 228-9097
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000167
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009234268
—
VA
01
—
079556
ANTHEM
VA
01
—
410001097
MEDICARE # DR. GRAU (SECOND DOCTOR IN PRACTICE)
VA
Enumeration date
12/18/2006
Last updated
06/20/2008
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