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General NPI Number Information
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NPI Number | 1447316286
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Entity Type | Organization
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Legal Business Name | STEEDLY OPTOMETRIC ASSOCIATES PA
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 3725 RAMSEY ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-7651
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Country | US
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Telephone | 910-488-4674
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Fax |
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Provider Business Mailing Address
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Address Line | 7298 THOR LN
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City | STEDMAN
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State | NC
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Zip | 28391-9659
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Country | US
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Telephone | 910-964-5407
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LARRY R STEEDLY
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Credential | O.D.
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Telephone | 910-964-5407
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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 | 1806
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License Number State | NC
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