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General NPI Number Information
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NPI Number | 1164824751
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Entity Type | Organization
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Legal Business Name | DM OPTICAL
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 2107 BARTLETT CIR
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City | HILLSBOROUGH
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State | NC
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Zip | 27278-6786
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Country | US
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Telephone | 919-672-3622
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Fax |
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Provider Business Mailing Address
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Address Line | 2107 BARTLETT CIR
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City | HILLSBOROUGH
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State | NC
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Zip | 27278-6786
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Country | US
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Telephone | 919-672-3622
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Fax |
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Authorized Official
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Title or Position | OPTICIAN
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Name | STEPHANIE JUNE STRAUGHAN
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Credential | L.D.O
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Telephone | 919-672-3622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 1906
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License Number State | NC
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