Healthcare Provider Details

I. General information

NPI: 1477792067
Provider Name (Legal Business Name): FINAL PHASE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 CEDAR POINT BLVD
CEDAR POINT NC
28584-8019
US

IV. Provider business mailing address

159 DEEPWATER DR
STELLA NC
28582-9741
US

V. Phone/Fax

Practice location:
  • Phone: 252-393-5134
  • Fax: 252-393-6930
Mailing address:
  • Phone: 252-393-5134
  • Fax: 252-393-6930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number021642
License Number StateNC

VIII. Authorized Official

Name: JAMES E HOMER
Title or Position: PRESIDENT
Credential: OCULARIST
Phone: 252-393-5134