Organization
CHATHAM OPTOMETRIC OD PA
Active
Other names
Carolina Vision Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN BRYAN MARSHALL O.D. (PRESIDENT)
(919) 933-6767
Entity
Organization
Contact information
Practice address
11312 US HIGHWAY 15-501 NORTH, STE 304, CHAPEL HILL, NC 27517-6376
(919) 933-6767
(919) 933-6732
Mailing address
11312 US HIGHWAY 15-501 NORTH, STE 304, CHAPEL HILL, NC 27517-6376
(919) 933-6767
(919) 933-6732
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NC
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
152W00000X
TAXONOMY NUMBER
NC
01
—
4480650001
MEDICARE PTAN
NC
05
—
790136L
—
NC
05
—
8909104
—
NC
Enumeration date
04/19/2007
Last updated
04/25/2012
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