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General NPI Number Information
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NPI Number | 1245450949
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Entity Type | Organization
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Legal Business Name | C. MARK BRITTAIN OD PA
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 644 STATESVILLE BLVD STE 3
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City | SALISBURY
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State | NC
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Zip | 28144-2281
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Country | US
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Telephone | 704-633-8975
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Fax | 704-633-9160
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Provider Business Mailing Address
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Address Line | 644 STATESVILLE BLVD STE 3
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City | SALISBURY
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State | NC
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Zip | 28144-2281
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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 | OWNER DOCTOR
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Name | CLIFFORD MARK BRITTAIN
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Credential |
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Telephone | 704-633-8975
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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 | 200001358217
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License Number State | NC
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