Healthcare Provider Details

I. General information

NPI: 1649228669
Provider Name (Legal Business Name): TRIAD EYE ASSOCIATES OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10564 N MAIN ST SUITE E
ARCHDALE NC
27263-2808
US

IV. Provider business mailing address

PO BOX 4370
ARCHDALE NC
27263-4370
US

V. Phone/Fax

Practice location:
  • Phone: 336-434-4033
  • Fax: 336-434-6680
Mailing address:
  • Phone: 336-434-4033
  • Fax: 336-434-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: LISA D MOODY
Title or Position: DIRECTOR OF INSURANCE
Credential:
Phone: 336-687-7730