Healthcare Provider Details

I. General information

NPI: 1477366870
Provider Name (Legal Business Name): TRIAD EYE ASSOCIATES OF KING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 KIRBY RD
KING NC
27021-9493
US

IV. Provider business mailing address

PO BOX 4370
ARCHDALE NC
27263-4370
US

V. Phone/Fax

Practice location:
  • Phone: 336-983-4313
  • Fax:
Mailing address:
  • Phone: 336-687-7730
  • Fax: 336-434-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: LISA D MOODY
Title or Position: DIRECTOR OF INSURANCE
Credential:
Phone: 336-687-7730