Healthcare Provider Details

I. General information

NPI: 1285665448
Provider Name (Legal Business Name): WASHINGTON EYE CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 W 15TH ST
WASHINGTON NC
27889-3526
US

IV. Provider business mailing address

639 W 15TH ST
WASHINGTON NC
27889-3526
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-2171
  • Fax: 252-946-5986
Mailing address:
  • Phone: 252-946-2171
  • Fax: 252-946-5986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1057
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number18081
License Number StateNC

VIII. Authorized Official

Name: MRS. LINDA JEWELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-946-2171