Organization
ACADEMY EYE CENTER OPTOMETRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIE MITCHELL (OFFICE ADMINISTRATOR)
(336) 905-9745
Entity
Organization
Contact information
Practice address
1040 RANDOLPH ST, SUITE 32, THOMASVILLE, NC 27360-6383
(336) 475-0151
(336) 472-6831
Mailing address
213 W NAOMI ST, RANDLEMAN, NC 27317-1733
(336) 495-3019
(336) 495-5703
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1464
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011KT
BCBS GROUP-T
NC
01
—
0853510001
CIGNA GOVERNMENT SERVICES MEDICARE PART B DME
NC
05
—
5901580
—
NC
Enumeration date
05/02/2007
Last updated
09/25/2009
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