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Organization

DOCTORS VISION CENTER OD PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TINA M BURGESS (CREDENTIALING SPECIALIST)
(252) 985-1371
Entity
Organization

Contact information

Practice address
413 MILL ST, ROCKY MOUNT, NC 27804-4837
(252) 985-1371
(252) 985-2303
Mailing address
PO BOX 7396, ROCKY MOUNT, NC 27804-0396
(252) 985-1371
(252) 985-2303

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
207W00000X
Ophthalmology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
019E5
BCBS OF NC GROUP NUMBER
NC
05
5906240
NC
01
CJ5982
RR MEDICARE GROUP
NC
Enumeration date
05/02/2006
Last updated
06/19/2008
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