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General NPI Number Information
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NPI Number | 1285665448
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Entity Type | Organization
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Legal Business Name | WASHINGTON EYE CLINIC, P.A.
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 12/23/2009
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Provider Practice Location Address
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Address Line | 639 W 15TH ST
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City | WASHINGTON
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State | NC
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Zip | 27889-3526
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Country | US
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Telephone | 252-946-2171
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Fax | 252-946-5986
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Provider Business Mailing Address
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Address Line | 639 W 15TH ST
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City | WASHINGTON
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State | NC
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Zip | 27889-3526
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Country | US
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Telephone | 252-946-2171
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Fax | 252-946-5986
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LINDA JEWELL
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Credential |
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Telephone | 252-946-2171
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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 | 1057
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 18081
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License Number State | NC
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