Healthcare Provider Details

I. General information

NPI: 1265740203
Provider Name (Legal Business Name): EYE CONSULTANTS OF GREENSBORO, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 N ELM ST SUITE 209
GREENSBORO NC
27455-2727
US

IV. Provider business mailing address

3810 N ELM ST SUITE 209
GREENSBORO NC
27455-2727
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 Code207W00000X
TaxonomyOphthalmology Physician
License Number26482
License Number StateNC

VIII. Authorized Official

Name: DR. ROY WHITAKER JR.
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 336-389-0242