Organization
PROFESSIONAL OPTICAL COMPANY OF WILMINGTON, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS L. BAYSE LICENSED OPTICIAN (OWNER)
(910) 392-6550
Entity
Organization
Contact information
Practice address
2226 S 17TH ST, WILMINGTON, NC 28401-7515
(910) 392-6550
(910) 784-9293
Mailing address
2226 S 17TH ST, WILMINGTON, NC 28401-7515
(910) 392-6550
(910) 784-9293
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
292
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0903J
BCBS HEALTHCHOICE
NC
01
—
093EH
BCBS
NC
05
—
8801815
—
NC
01
—
NC0292
EYEMED
NC
Enumeration date
12/03/2007
Last updated
04/12/2011
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