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General NPI Number Information
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NPI Number | 1124449178
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Entity Type | Organization
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Legal Business Name | TRADEWINDS OPTOMETRIC GROUP, PLLC
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 594 RIVER HWY
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City | MOORESVILLE
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State | NC
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Zip | 28117-6829
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Country | US
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Telephone | 352-642-4542
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Fax |
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Provider Business Mailing Address
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Address Line | 594 RIVER HWY
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City | MOORESVILLE
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State | NC
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Zip | 28117-6829
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KENDRA J HATFIELD
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Credential | OD
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Telephone | 352-642-4542
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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 | 2195
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License Number State | NC
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