Port City Optometry, Pllc | |
8035 Market St Ofc, Wilmington, NC 28411-9385 | |
(910) 200-0635 | |
Not Available |
Full Name | Port City Optometry, Pllc |
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Type | Facility |
Speciality | Optometrist |
Location | 8035 Market St Ofc, Wilmington, North Carolina |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1821715772 | NPI | - | NPPES |
1750717336 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Primary |
Provider Name | Rasika Khatu Whitesell |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1750717336 PECOS PAC ID: 8224264296 Enrollment ID: I20131121000813 |
Mailing Address | Practice Location Address |
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Port City Optometry, Pllc 3259 Kellerton Pl, Wilmington, NC 28409-4261 Ph: (910) 200-0635 | Port City Optometry, Pllc 8035 Market St Ofc, Wilmington, NC 28411-9385 Ph: (910) 200-0635 |
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