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General NPI Number Information
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NPI Number | 1427248707
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Entity Type | Organization
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Legal Business Name | PORT CITY EYE ASSOCIATES, OD, P.A.
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 03/27/2010
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Provider Practice Location Address
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Address Line | 8262 MARKET ST SUITE 103
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City | WILMINGTON
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State | NC
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Zip | 28411-9805
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Country | US
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Telephone | 910-686-3396
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Fax | 910-686-3398
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Provider Business Mailing Address
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Address Line | 8262 MARKET ST SUITE 103
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City | WILMINGTON
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State | NC
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Zip | 28411-9805
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Country | US
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Telephone | 910-686-3396
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Fax | 910-686-3398
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Authorized Official
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Title or Position | PRACTICE COORDINATOR
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Name | ABBIE C PREVATT
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Credential |
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Telephone | 910-947-6285
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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 | 1904
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License Number State | NC
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