Healthcare Provider Details

I. General information

NPI: 1467459859
Provider Name (Legal Business Name): STEVEN G LAYMON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198B HOSPITAL ST
MOCKSVILLE NC
27028-2008
US

IV. Provider business mailing address

198B HOSPITAL ST
MOCKSVILLE NC
27028-2008
US

V. Phone/Fax

Practice location:
  • Phone: 336-751-5734
  • Fax: 336-751-4968
Mailing address:
  • Phone: 336-751-5734
  • Fax: 336-751-4968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1193
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: