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General NPI Number Information
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NPI Number | 1043304215
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Entity Type | Organization
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Legal Business Name | GREENSBORO OPHTHALMOLOGY ASSOC PA
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 8 N POINTE CT
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City | GREENSBORO
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State | NC
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Zip | 27408-3187
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Country | US
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Telephone | 336-274-4626
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Fax | 336-274-7952
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Provider Business Mailing Address
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Address Line | 8 N POINTE CT
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City | GREENSBORO
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State | NC
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Zip | 27408-3187
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Country | US
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Telephone | 336-274-4626
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Fax | 336-274-7952
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | AMANDA JACKSON
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Credential | RN, MSN
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Telephone | 336-274-4626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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