Healthcare Provider Details

I. General information

NPI: 1003966789
Provider Name (Legal Business Name): TRI CITY OPTOMETRIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/15/2010
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 TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1807
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1807
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1807
License Number StateNC

VIII. Authorized Official

Name: DR. TROY N TEVIS
Title or Position: OWNER DOCTOR
Credential: O.D., PHD
Phone: 828-288-8662