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General NPI Number Information
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NPI Number | 1265740203
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Entity Type | Organization
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Legal Business Name | EYE CONSULTANTS OF GREENSBORO, P.A.
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 3810 N ELM ST SUITE 209
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City | GREENSBORO
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State | NC
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Zip | 27455-2727
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Country | US
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Telephone | 336-389-0242
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Fax | 336-389-0263
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Provider Business Mailing Address
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Address Line | 3810 N ELM ST SUITE 209
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City | GREENSBORO
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State | NC
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Zip | 27455-2727
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Country | US
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Telephone | 336-389-0242
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Fax | 336-389-0263
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ROY WHITAKER JR.
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Credential | M.D.
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Telephone | 336-389-0242
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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 | 26482
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License Number State | NC
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