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General NPI Number Information
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NPI Number | 1144607128
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Entity Type | Organization
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Legal Business Name | WALDO'S OPTICAL
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Dates
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Enumeration Date | 04/29/2015
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Last Update Date | 04/29/2015
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Provider Practice Location Address
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Address Line | 2500 SPRING GARDEN ST. SUITE C
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City | GREENSBORO
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State | NC
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Zip | 27403
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Country | US
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Telephone | 336-818-8733
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 SPRING GARDEN ST SUITE C
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City | GREENSBORO
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State | NC
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Zip | 27403-2696
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Country | US
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Telephone | 336-818-8733
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Fax |
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Authorized Official
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Title or Position | OPTICIAN/OWNER
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Name | HERBERT WALDO FORREST
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Credential |
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Telephone | 336-818-8733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 421
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License Number State | NC
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