Healthcare Provider Details

I. General information

NPI: 1679609382
Provider Name (Legal Business Name): TROY NATHANIEL TEVIS OD., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 N MAIN ST
RUTHERFORDTON NC
28139-2505
US

IV. Provider business mailing address

337 N MAIN ST
RUTHERFORDTON NC
28139-2505
US

V. Phone/Fax

Practice location:
  • Phone: 828-288-8662
  • Fax: 828-288-4882
Mailing address:
  • Phone: 828-288-8662
  • Fax: 828-288-4882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1807
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1807
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1807
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: