Healthcare Provider Details

I. General information

NPI: 1699355495
Provider Name (Legal Business Name): TOM GLENN DELLINGER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W CHURCH ST
CHERRYVILLE NC
28021-2805
US

IV. Provider business mailing address

PO BOX 160
CHERRYVILLE NC
28021-0160
US

V. Phone/Fax

Practice location:
  • Phone: 704-435-2020
  • Fax:
Mailing address:
  • Phone: 704-435-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2636
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: