Organization
PROFESSIONAL OPTICAL COMPANY OF WILMINGTON, INC.
Active
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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