Healthcare Provider Details

I. General information

NPI: 1689048423
Provider Name (Legal Business Name): CENTRAL TRIAD RETINA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BROOKVIEW HILLS BLVD STE 107
WINSTON SALEM NC
27103-5661
US

IV. Provider business mailing address

3333 BROOKVIEW HILLS BLVD SUITE 107
WINSTON SALEM NC
27103-5661
US

V. Phone/Fax

Practice location:
  • Phone: 336-970-5900
  • Fax: 336-842-3964
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDY PRESSLEY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 336-970-5900