Organization
LAKE DRIVE OPTICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM DAVID THOMAS (OWNER/OPTICIAN)
(540) 345-0111
Entity
Organization
Contact information
Practice address
224 S POLLARD ST, VINTON, VA 24179-2530
(540) 345-0111
Mailing address
224 S POLLARD ST, VINTON, VA 24179-2530
(540) 345-0111
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
1101000159
VA
Other
Enumeration date
07/22/2008
Last updated
07/22/2008
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