Healthcare Provider Details

I. General information

NPI: 1023203130
Provider Name (Legal Business Name): RHONDA S THURMOND OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 W FRIENDLY AVE SUITE 200
GREENSBORO NC
27410-4368
US

IV. Provider business mailing address

5500 W FRIENDLY AVE SUITE 200
GREENSBORO NC
27410-4368
US

V. Phone/Fax

Practice location:
  • Phone: 336-292-4516
  • Fax: 336-292-5706
Mailing address:
  • Phone: 336-292-4516
  • Fax: 336-292-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1481
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1481
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: