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General NPI Number Information
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NPI Number | 1386830701
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Entity Type | Organization
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Legal Business Name | SANFORD OPTOMETRIC OD PA
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 1829 DOCTORS DRIVE
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City | SANFORD
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State | NC
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Zip | 27330-5067
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Country | US
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Telephone | 919-776-2032
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Fax | 919-775-2179
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Provider Business Mailing Address
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Address Line | 1829 DOCTORS DRIVE
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City | SANFORD
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State | NC
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Zip | 27330-5067
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Country | US
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Telephone | 919-776-2032
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Fax | 919-775-2179
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN BRYAN MARSHALL
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Credential | O.D.
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Telephone | 919-776-2032
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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 | 1551
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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