Provider Demographics
NPI:1548475601
Name:OPTOMETRIC ASSOCIATES
Entity type:Organization
Organization Name:OPTOMETRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:908-685-0033
Mailing Address - Street 1:628 NEW RIVER RD
Mailing Address - Street 2:NEW RIVER VALLEY MALL
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6500
Mailing Address - Country:US
Mailing Address - Phone:540-382-5511
Mailing Address - Fax:540-382-1904
Practice Address - Street 1:628 NEW RIVER RD
Practice Address - Street 2:NEW RIVER VALLEY MALL
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6500
Practice Address - Country:US
Practice Address - Phone:540-382-5511
Practice Address - Fax:540-382-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601001000152W00000X
VA0601000680152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty