Healthcare Provider Details

I. General information

NPI: 1639142656
Provider Name (Legal Business Name): GREENSBORO OPHTHALMOLOGY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 BATTLEGROUND AVENUE
GREENSBORO NC
27410-2402
US

IV. Provider business mailing address

3312 BATTLEGROUND AVENUE
GREENSBORO NC
27410-2402
US

V. Phone/Fax

Practice location:
  • Phone: 336-282-8331
  • Fax: 336-282-2625
Mailing address:
  • Phone: 336-282-8331
  • Fax: 336-282-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberAS0033
License Number StateNC

VIII. Authorized Official

Name: DAWN D APPLE
Title or Position: MANAGER
Credential:
Phone: 910-255-2070