| |
340a Northeast Blvd, Clinton, NC 28328-2424 | |
(910) 592-5379 | |
(910) 592-5353 |
Full Name | |
---|---|
Type | Facility |
Speciality | Technician/technologist - Ophthalmic |
Location | 340a Northeast Blvd, Clinton, North Carolina |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1134634553 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
156FX1100X | Technician/technologist - Ophthalmic | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
Po Box 40908, Attn: Pfs Provider Enrollment, Fayetteville, NC 28309-0908 Ph: (910) 615-6949 | 340a Northeast Blvd, Clinton, NC 28328-2424 Ph: (910) 592-5379 |