Healthcare Provider Details

I. General information

NPI: 1780707984
Provider Name (Legal Business Name): JOHN ROBERT SCIBAL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 PAMLICO PLZ
WASHINGTON NC
27889-3337
US

IV. Provider business mailing address

1102 SHEPARD ST
MOREHEAD CITY NC
28557-4155
US

V. Phone/Fax

Practice location:
  • Phone: 252-948-2680
  • Fax:
Mailing address:
  • Phone: 252-349-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1125
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: