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General NPI Number Information
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NPI Number | 1043691595
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNT EYE PA
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Dates
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Enumeration Date | 06/10/2015
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 450 JONES RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-8207
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Country | US
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Telephone | 252-443-1006
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Fax | 252-937-8366
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Provider Business Mailing Address
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Address Line | 450 JONES RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-8207
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Country | US
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Telephone | 252-443-1006
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Fax | 252-937-8366
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS J ROBERTSON JR.
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Credential | M.D.
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Telephone | 252-443-1006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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