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General NPI Number Information
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NPI Number | 1558543884
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Entity Type | Organization
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Legal Business Name | EAST CAROLINA OPTOMETRIC CARE, PA
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 2322 JAMES B WHITE HWY N
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City | WHITEVILLE
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State | NC
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Zip | 28472
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Country | US
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Telephone | 910-914-6442
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Fax |
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Provider Business Mailing Address
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Address Line | 2322 JAMES B. WHITE HWY NORTH
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City | WHITEVILLE
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State | NC
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Zip | 28472
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Country | US
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Telephone | 910-914-6442
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER/PRESIDENT
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Name | DR. TIFFANY L. JACKSON
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Credential | O.D.
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Telephone | 910-540-1969
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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 |
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License Number State |
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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 | 1900
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License Number State | NC
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