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General NPI Number Information
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NPI Number | 1437337136
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Entity Type | Organization
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Legal Business Name | OPTOMETRIC EYE SITE PLLC
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 200 N COOPER DR WAL MART VISION CENTER
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City | HENDERSON
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State | NC
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Zip | 27536-4016
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Country | US
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Telephone | 252-430-7708
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12134 OPTOMETRIC EYE SITE PLLC
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City | DURHAM
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State | NC
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Zip | 27709-2134
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID COWARD
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Credential | O.D.
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Telephone | 312-771-7411
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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 | NC 1947
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License Number State | NC
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