Healthcare Provider Details

I. General information

NPI: 1689622888
Provider Name (Legal Business Name): PERRY C. MOTSINGER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 US HIGHWAY 117 S SUITE 4
BURGAW NC
28425-6704
US

IV. Provider business mailing address

205 US HIGHWAY 117 S SUITE 4
BURGAW NC
28425-6704
US

V. Phone/Fax

Practice location:
  • Phone: 910-259-9230
  • Fax: 910-259-9215
Mailing address:
  • Phone: 910-259-9230
  • Fax: 910-259-9215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1869
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: