Organization
DOCTORS VISION CENTER OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA M BURGESS (CREDENTIALING SPECIALIST)
(252) 442-0802
Entity
Organization
Contact information
Practice address
335 N MAIN ST, WALNUT COVE, NC 27052-9200
(336) 591-7428
(336) 591-5136
Mailing address
335 N MAIN ST, WALNUT COVE, NC 27052-9200
(336) 591-7428
(336) 591-5136
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017J2
BCBS GRP #
NC
05
—
5900612
—
NC
Enumeration date
05/04/2006
Last updated
08/30/2011
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