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General NPI Number Information
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NPI Number | 1003966789
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Entity Type | Organization
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Legal Business Name | TRI CITY OPTOMETRIC, P.A.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 337 N MAIN ST
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City | RUTHERFORDTON
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State | NC
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Zip | 28139-2505
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Country | US
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Telephone | 828-288-8662
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Fax | 828-288-4882
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Provider Business Mailing Address
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Address Line | 337 N MAIN ST
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City | RUTHERFORDTON
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State | NC
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Zip | 28139-2505
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Country | US
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Telephone | 828-288-8662
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Fax | 828-288-4882
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. TROY N TEVIS
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Credential | O.D., PHD
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Telephone | 828-288-8662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 1807
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 1807
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1807
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License Number State | NC
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