Healthcare Provider Details

I. General information

NPI: 1326006503
Provider Name (Legal Business Name): DOCTORS VISION CENTER OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W STATE ST SUITE 2
BLACK MOUNTAIN NC
28711-6300
US

IV. Provider business mailing address

601 W STATE ST SUITE 2
BLACK MOUNTAIN NC
28711-6300
US

V. Phone/Fax

Practice location:
  • Phone: 252-669-2747
  • Fax: 252-669-2749
Mailing address:
  • Phone: 252-669-2747
  • Fax: 252-669-2749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: TINA M BURGESS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 25298513714