Healthcare Provider Details

I. General information

NPI: 1083664940
Provider Name (Legal Business Name): MIDLAND OPTOMETRIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160B MIDLAND RD SUITE B
SOUTHERN PINES NC
28387-2927
US

IV. Provider business mailing address

2160B MIDLAND RD SUITE B
SOUTHERN PINES NC
28387-2927
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-3220
  • Fax: 910-295-0507
Mailing address:
  • Phone: 910-295-3220
  • Fax: 910-295-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CATHERINE M LOFTIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-295-3220