Healthcare Provider Details

I. General information

NPI: 1255454468
Provider Name (Legal Business Name): DAVID WATKINS BURKE COT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 GRAYSTONE PL
CONOVER NC
28613-8201
US

IV. Provider business mailing address

PO BOX 3122
MORGANTON NC
28680-3122
US

V. Phone/Fax

Practice location:
  • Phone: 828-322-2050
  • Fax: 828-324-4271
Mailing address:
  • Phone: 828-433-5760
  • Fax: 828-324-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number42218
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: