Provider Demographics
NPI:1871613083
Name:HOMETOWN OPTICS
Entity type:Organization
Organization Name:HOMETOWN OPTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNERMANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:540-665-0255
Mailing Address - Street 1:2017 S LOUDOUN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3612
Mailing Address - Country:US
Mailing Address - Phone:540-665-0255
Mailing Address - Fax:540-665-0257
Practice Address - Street 1:2017 S LOUDOUN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3612
Practice Address - Country:US
Practice Address - Phone:540-665-0255
Practice Address - Fax:540-665-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101002510156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAST207069OtherBLUECROSSBLUESHIELD PA
VA287005OtherBLUECROSSBLUESHIELD
VAVA2510OtherEYEMEDVISIONCARE