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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