Blackstock, Joe Riley

Blackstock, Joe Riley is an individual health care provider with primary practice located at 5049A Valley View Blvd , Roanoke VA 24012-2075. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Blackstock, Joe Riley can be contacted via phone (540) 362-7565.

Contact Information

Primary practice address
5049A Valley View Blvd Roanoke VA 24012-2075
Phone: (540) 362-7565
Fax: (540) 563-0441
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 0618000713 Virginia

Profile Details

NPI number 1497720437
LBN Legal business name Blackstock, Joe Riley
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 22nd, 2006
Last updated Feb 20th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497720437 NPPES
Virginia MEDICAID 009203460

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