Healthcare Provider Details

I. General information

NPI: 1689695751
Provider Name (Legal Business Name): GREENVILLE EYE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 HEMBY LN
GREENVILLE NC
27834-3733
US

IV. Provider business mailing address

2425 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 Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

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