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
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