Organization
DOCTORS VISION CENTER OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA M BURGESS (CREDENTIALING SPECIALIST)
25298513714
Entity
Organization
Contact information
Practice address
601 W STATE ST, SUITE 2, BLACK MOUNTAIN, NC 28711-6300
(252) 669-2747
(252) 669-2749
Mailing address
601 W STATE ST, SUITE 2, BLACK MOUNTAIN, NC 28711-6300
(252) 669-2747
(252) 669-2749
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
207W00000X
Ophthalmology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016UC
BCBS GRP #
NC
Enumeration date
05/03/2006
Last updated
09/11/2025
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