Healthcare Provider Details

I. General information

NPI: 1265424246
Provider Name (Legal Business Name): BILLY KEITH CASH O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2596 REYNOLDA RD STE A
WINSTON-SALEM NC
27106-4651
US

IV. Provider business mailing address

2596 REYNOLDA RD STE A
WINSTON-SALEM NC
27106-4651
US

V. Phone/Fax

Practice location:
  • Phone: 336-777-1722
  • Fax: 336-725-6954
Mailing address:
  • Phone: 336-777-1722
  • Fax: 336-725-6954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1080
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: