# TRIAD PEDIATRIC EYE PHYSICIANS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093234007
- **Authorized official:** JENNIFER HEIN (PRACTICE MANAGER)
- **Authorized official phone:** (336) 245-8320

## Contact information

- **Practice address:** 2554 LEWISVILLE CLEMMONS RD STE 308, CLEMMONS, NC 27012-8749
- **Practice address phone:** (336) 245-8320
- **Practice address fax:** (336) 293-4857
- **Mailing address:** 2554 LEWISVILLE CLEMMONS RD STE 308, CLEMMONS, NC 27012-8749
- **Mailing address phone:** (336) 245-8320
- **Mailing address fax:** (336) 293-4857

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | — | — |
| 207WX0110X | Pediatric Ophthalmology and Strabismus Specialist Physician | 2010-01965 | NC | Yes |

## Other

- **Enumeration date:** 09/12/2017
- **Last updated:** 07/21/2022