Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618001966 | VA |
NPI | 1003128505 |
---|---|
Provider Name | Dr. Amber Colling |
First Address | Forest, VA 24551-1290 |
Second Address | Bedford, VA 24523-2636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2010 |
Last Update Date | 24/05/2013 |