Healthcare Provider Details

I. General information

NPI: 1972948024
Provider Name (Legal Business Name): ENVOLVE TOTAL VISION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ZEBULON COURT
ROCKY MOUNT NC
27804-2420
US

IV. Provider business mailing address

112 ZEBULON COURT
ROCKY MOUNT NC
27804-2420
US

V. Phone/Fax

Practice location:
  • Phone: 800-334-3937
  • Fax:
Mailing address:
  • Phone: 800-334-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID MICHAEL LAVELY
Title or Position: PRESIDENT & CEO
Credential: O.D.
Phone: 252-544-9200