Provider Demographics
NPI:1679177893
Name:BLUE RIDGE EYE ASSOCIATES OF ROCKBRIDGE COUNTY LLC
Entity type:Organization
Organization Name:BLUE RIDGE EYE ASSOCIATES OF ROCKBRIDGE COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PETRIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-275-9404
Mailing Address - Street 1:30 CROSSING LN STE 107
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-6354
Mailing Address - Country:US
Mailing Address - Phone:847-275-9404
Mailing Address - Fax:540-463-1722
Practice Address - Street 1:30 CROSSING LN STE 107
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-6354
Practice Address - Country:US
Practice Address - Phone:847-275-9404
Practice Address - Fax:540-463-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty