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General NPI Number Information
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NPI Number | 1154503027
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL OPTICAL COMPANY OF WILMINGTON, INC.
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 2226 S 17TH ST
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City | WILMINGTON
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State | NC
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Zip | 28401-7515
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Country | US
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Telephone | 910-392-6550
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Fax | 910-784-9293
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Provider Business Mailing Address
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Address Line | 2226 S 17TH ST
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City | WILMINGTON
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State | NC
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Zip | 28401-7515
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Country | US
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Telephone | 910-392-6550
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Fax | 910-784-9293
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Authorized Official
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Title or Position | OWNER
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Name | MR. DOUGLAS L. BAYSE
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Credential | LICENSED OPTICIAN
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Telephone | 910-392-6550
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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 | 292
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License Number State | NC
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