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General NPI Number Information
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NPI Number | 1396966602
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Entity Type | Organization
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Legal Business Name | ACADEMY EYE CENTER OPTOMETRY, PA
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 108 W MAIN ST
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City | BISCOE
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State | NC
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Zip | 27209-9526
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Country | US
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Telephone | 910-428-4900
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Fax | 910-428-4909
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Provider Business Mailing Address
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Address Line | 1120 RANDOLPH ST STE 32
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City | THOMASVILLE
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State | NC
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Zip | 27360-5759
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Country | US
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Telephone | 336-495-3019
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Fax | 336-495-5703
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANFORD RAYNOR
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Credential | OD
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Telephone | 336-460-0499
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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 | 1464
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License Number State | NC
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