Organization
BUENA VISTA EYE PC
Active
Organization
BUENA VISTA EYE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY BARTA WALL MD (PRESIDENT)
(336) 723-2555
Entity
Organization
Contact information
Practice address
1214 REYNOLDA RD, SUITE A, WINSTON SALEM, NC 27104-1122
(336) 723-2555
(336) 723-9007
Mailing address
1214 REYNOLDA RD, SUITE A, WINSTON SALEM, NC 27104-1122
(336) 723-2555
(336) 723-9007
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
9800734
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012T3
BCBS
NC
05
—
89012T3
—
NC
Enumeration date
11/08/2005
Last updated
11/03/2010
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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