Organization
MYRTLE GROVE OPTICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY G. KELLY M.D. (OWNER)
(910) 762-2300
Entity
Organization
Contact information
Practice address
1917 TRADD CT, WILMINGTON, NC 28401-6638
(910) 762-2300
Mailing address
1917 TRADD CT, WILMINGTON, NC 28401-6638
(910) 762-2300
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
0735
NC
Other
Enumeration date
05/08/2007
Last updated
08/22/2020
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