Healthcare Provider Details

I. General information

NPI: 1215049291
Provider Name (Legal Business Name): EYE CONSULTANTS OF GREENSBORO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W WENDOVER AVE SUITE B
GREENSBORO NC
27408-8124
US

IV. Provider business mailing address

1305 W WENDOVER AVE SUITE B
GREENSBORO NC
27408-8124
US

V. Phone/Fax

Practice location:
  • Phone: 336-389-0242
  • Fax: 336-389-0263
Mailing address:
  • Phone: 336-389-0242
  • Fax: 336-389-0263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number26482
License Number StateNC

VIII. Authorized Official

Name: ROY WHITAKER JR.
Title or Position: OWNER
Credential: MD
Phone: 336-389-0242