Healthcare Provider Details

I. General information

NPI: 1841211828
Provider Name (Legal Business Name): GREENVILLE OPTICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425A HEMBY LN
GREENVILLE NC
27834-3733
US

IV. Provider business mailing address

2425A HEMBY LN
GREENVILLE NC
27834-3733
US

V. Phone/Fax

Practice location:
  • Phone: 252-758-4166
  • Fax: 252-758-5456
Mailing address:
  • Phone: 252-758-4166
  • Fax: 252-758-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number200001362627
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number200001362627
License Number StateNC

VIII. Authorized Official

Name: JANET WHITE
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-758-4166