| NPI | 1184728503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OTIS W BLACKWOOD Practice Administrator 540-772-3672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101044009) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: VA 0101048225) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2025-09-11 |