Organization
WALLY BETTON OD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALLY BETTON O.D. (OWNER)
(276) 647-3766
Entity
Organization
Contact information
Practice address
4244 VIRGINIA AVE, COLLINSVILLE, VA 24078-1935
(276) 647-3766
(276) 647-4279
Mailing address
4244 VIRGINIA AVE, COLLINSVILLE, VA 24078-1935
(276) 647-3766
(276) 647-4279
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000209
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010145660
—
VA
05
—
010332770
—
VA
05
—
010337399
—
VA
Enumeration date
09/26/2006
Last updated
06/29/2012
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