Healthcare Provider Details

I. General information

NPI: 1477853414
Provider Name (Legal Business Name): ALAMANCE EYE PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 MAPLE AVE
BURLINGTON NC
27215-6846
US

IV. Provider business mailing address

1736 MAPLE AVE
BURLINGTON NC
27215-6846
US

V. Phone/Fax

Practice location:
  • Phone: 336-228-1403
  • Fax: 336-228-1503
Mailing address:
  • Phone: 336-228-1403
  • Fax: 336-228-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL WILLIAM BOYD
Title or Position: PRESIDENT
Credential: OCULARIST
Phone: 336-228-1403