Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Other names
Duke Eye Winston Salem
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER THOMAS FREDERICK (CFO)
(919) 613-7762
Entity
Organization
Contact information
Practice address
2025 FRONTIS PLAZA BLVD, SUITE 100, WINSTON SALEM, NC 27103-5663
(336) 768-3240
Mailing address
PO BOX 110566, DURHAM, NC 27709-5566
(919) 620-4855
(919) 620-4921
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8902034
—
NC
Enumeration date
09/20/2006
Last updated
07/11/2022
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