Healthcare Provider Details

I. General information

NPI: 1902454937
Provider Name (Legal Business Name): AMANDA MARIE CULLER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 11/28/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MOORE RD
KING NC
27021-8703
US

IV. Provider business mailing address

215 MOORE RD
KING NC
27021-8703
US

V. Phone/Fax

Practice location:
  • Phone: 336-985-2020
  • Fax: 336-985-2133
Mailing address:
  • Phone: 336-985-2020
  • Fax: 336-985-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2568
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: