Healthcare Provider Details

I. General information

NPI: 1861841520
Provider Name (Legal Business Name): ONSLOW OPHTHALMOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 KINSTON HWY
RICHLANDS NC
28574-6420
US

IV. Provider business mailing address

6 OFFICE PARK DR
JACKSONVILLE NC
28546-7325
US

V. Phone/Fax

Practice location:
  • Phone: 910-355-3937
  • Fax: 910-347-6663
Mailing address:
  • Phone: 910-355-3937
  • Fax: 910-347-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATH B ERGAS
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 910-355-3937