Healthcare Provider Details

I. General information

NPI: 1932353976
Provider Name (Legal Business Name): YADKIN VISION CENTER O.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PAULINE ST
EAST BEND NC
27018-7686
US

IV. Provider business mailing address

115 PAULINE ST
EAST BEND NC
27018-7686
US

V. Phone/Fax

Practice location:
  • Phone: 336-699-8170
  • Fax: 336-699-8162
Mailing address:
  • Phone: 336-699-8170
  • Fax: 336-699-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT GORDON
Title or Position: MEMBER/MANAGER
Credential: O.D.
Phone: 336-679-2931