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General NPI Number Information
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NPI Number | 1255436127
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Entity Type | Organization
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Legal Business Name | ATLANTIC EYE ASSOCIATES OD PA
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 16150 US HWY 17 N SUITE A
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City | HAMPSTEAD
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State | NC
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Zip | 28443
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Country | US
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Telephone | 910-270-2800
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Fax | 910-270-9100
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Provider Business Mailing Address
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Address Line | 16150 US HWY 17 N SUITE A
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City | HAMPSTEAD
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State | NC
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Zip | 28443
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Country | US
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Telephone | 910-270-2800
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Fax | 910-270-9100
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK ROBERT FLORA
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Credential | OD
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Telephone | 910-270-2800
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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 | 1143
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License Number State | NC
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