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
520 DUNN-ERWIN ROAD, DUNN, NC 28334
(910) 892-7002
(910) 892-8536
Mailing address
PO BOX 7396, ROCKY MOUNT, NC 27804-0396
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0129N
BCBS GRP #
NC
01
—
246648N
MEDICARE GROUP NUMBER
NC
01
—
890129N
MEDICAID GROUP NUMBER
NC
Enumeration date
05/05/2006
Last updated
12/16/2008
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