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Individual

MR. DEXTER WAYNE STREET

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1375
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
09878
BLUE CROSS BLUE SHIELD
NC
01
2208005
UNITED HEALTHCARE
NC
01
410038739
RAILROAD MEDICARE
NC
01
431657
ANTHEM
VA
05
7909878
NC
Enumeration date
04/04/2006
Last updated
11/30/2011
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