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Organization

MODERN OPTICAL, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ROGER DWIGHT THOMAS SR. (OWNER)
(919) 775-5221
Entity
Organization

Contact information

Practice address
2648 LEE AVE, SANFORD, NC 27332-5950
(919) 775-5221
Mailing address
2648 LEE AVE, SANFORD, NC 27332-5950
(919) 775-5221

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
0710
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8801952
NC
Enumeration date
03/05/2007
Last updated
02/06/2008
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