Healthcare Provider Details

I. General information

NPI: 1386866762
Provider Name (Legal Business Name): TUNNEL ROAD OPTOMETRY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 W GATE CITY BLVD ADVANCED EYE CARE
GREENSBORO NC
27407-4628
US

IV. Provider business mailing address

3316 SILAS CREEK PKWY
WINSTON SALEM NC
27103-3011
US

V. Phone/Fax

Practice location:
  • Phone: 336-854-2020
  • Fax: 336-852-9472
Mailing address:
  • Phone: 336-765-5350
  • Fax: 336-765-0769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROGER G DAVIS
Title or Position: PRESIDENT
Credential: OD
Phone: 336-765-5350