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General NPI Number Information
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NPI Number | 1124083167
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Entity Type | Organization
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Legal Business Name | WAYNESBOROUGH OPHTHALMOLOGY, P.A.
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 103 COX BLVD
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City | GOLDSBORO
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State | NC
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Zip | 27534-9478
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Country | US
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Telephone | 919-734-8440
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Fax | 919-734-9387
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Provider Business Mailing Address
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Address Line | 103 COX BLVD
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City | GOLDSBORO
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State | NC
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Zip | 27534-9478
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Country | US
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Telephone | 919-734-8440
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Fax | 919-734-9387
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER FAYE JORDAN
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Credential | MD
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Telephone | 919-734-8440
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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 | 1019
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License Number State | NC
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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 | 25961
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License Number State | NC
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