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General NPI Number Information
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NPI Number | 1588274963
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Entity Type | Organization
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Legal Business Name | WILMINGTON EYE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 1919 S 16TH ST
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City | WILMINGTON
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State | NC
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Zip | 28401-6610
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Country | US
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Telephone | 910-772-8261
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Fax |
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Provider Business Mailing Address
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Address Line | 1729 NEW HANOVER MEDICAL PARK DR
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City | WILMINGTON
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State | NC
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Zip | 28403-5345
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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 | AUTHORIZED OFFICIAL
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Name | KATHY ERICKSON
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Credential | RN
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Telephone | 910-763-3601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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