Organization
MEDICAL OPTICAL LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DIANA G DAUGHERTY OFFICE MANAGER (OFFICE MANAGER)
(540) 667-7482
Entity
Organization
Contact information
Practice address
302 S CAMERON ST, WINCHESTER, VA 22601-4063
(540) 667-7482
(540) 667-8765
Mailing address
302 S CAMERON ST, WINCHESTER, VA 22601-4603
(540) 667-7482
(540) 667-8765
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
317108
BCBS
—
Enumeration date
08/21/2006
Last updated
02/06/2008
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