|
| |
|
106 N King Street, Windsor, NC 27983-6863 | |
| (252) 794-3381 | |
| (252) 794-3371 |
| Full Name | |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 106 N King Street, Windsor, North Carolina |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306083803 | NPI | - | NPPES |
| 5950660 | Medicaid | NC | |
| 8802140 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | NC1332 (North Carolina) | Primary |
| 152WC0802X | Optometrist - Corneal And Contact Management | NC1332 (North Carolina) | Secondary |
| Mailing Address | Practice Location Address |
|---|---|
P.o. Box 160, Windsor, NC 27983-6863 Ph: (252) 794-3381 | 106 N King Street, Windsor, NC 27983-6863 Ph: (252) 794-3381 |
Kerry P Sullivan Od Optometrist Medicare: Not Enrolled in Medicare Practice Location: 106 N King St, Windsor, NC 27983 Phone: 252-794-3381 | |
Kerry P Sullivan, OD Optometrist Medicare: Not Enrolled in Medicare Practice Location: 106 N King St, Windsor, NC 27983 Phone: 252-794-3381 | |
David Lauren Fitzgerald Od Pa Optometrist Medicare: Not Enrolled in Medicare Practice Location: 105 E Granville St, Windsor, NC 27983 Phone: 252-974-3381 Fax: 252-794-3371 |