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General NPI Number Information
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NPI Number | 1225281876
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Entity Type | Organization
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Legal Business Name | PIEDMONT EYE SURGICAL AND LASER PLLC
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 12/30/2008
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Provider Practice Location Address
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Address Line | 1002 N CHURCH ST SUITE 200
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City | GREENSBORO
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State | NC
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Zip | 27401-1439
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Country | US
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Telephone | 336-854-4441
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Fax | 336-854-7883
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Provider Business Mailing Address
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Address Line | 1002 N CHURCH ST SUITE 200
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City | GREENSBORO
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State | NC
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Zip | 27401-1439
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Country | US
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Telephone | 336-854-4441
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Fax | 336-854-7883
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY R BEVIS
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Credential | MD
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Telephone | 336-854-4441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 200600935
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License Number State | NC
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