Individual
LOGAN OLIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
18 GRAYSON ST, SPARTA, NC 28675-6006
(336) 372-4493
(336) 372-2035
Mailing address
18 GRAYSON ST, PO BOX 1119, SPARTA, NC 28675-6006
(336) 372-4493
(336) 372-2035
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2461
NC
Other
Enumeration date
08/24/2016
Last updated
08/24/2016
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