Provider Demographics
NPI:1346032646
Name:RIVER CITY OPTICAL LLC
Entity type:Organization
Organization Name:RIVER CITY OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:AMBER
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:434-228-7506
Mailing Address - Street 1:308 CRAGHEAD ST STE 102B
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1468
Mailing Address - Country:US
Mailing Address - Phone:434-228-7506
Mailing Address - Fax:434-228-7584
Practice Address - Street 1:308 CRAGHEAD ST STE 102B
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1468
Practice Address - Country:US
Practice Address - Phone:434-228-7506
Practice Address - Fax:434-228-7584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1134952690OtherINDIVIDUAL NPI