Organization
SPECTACLE ENVY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLEY J TAYLOR NCLDO (OPTICIAN)
(336) 231-3135
Entity
Organization
Contact information
Practice address
66 COURT SQ, MOCKSVILLE, NC 27028-2415
(336) 231-3135
(336) 753-1335
Mailing address
66 COURT SQ, MOCKSVILLE, NC 27028-2415
(336) 231-3135
(336) 753-1335
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
2087
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PE-VGN87USX7
—
NC
Enumeration date
06/08/2017
Last updated
07/21/2022
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