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General NPI Number Information
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NPI Number | 1598277402
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Entity Type | Organization
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Legal Business Name | PATTY VISION CENTER OD PA
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Dates
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Enumeration Date | 11/01/2017
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 1107 S FIFTH ST STE 300
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City | MEBANE
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State | NC
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Zip | 27302-9896
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Country | US
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Telephone | 919-241-8554
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Fax | 336-597-3356
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Provider Business Mailing Address
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Address Line | 1107 S FIFTH ST STE 300
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City | MEBANE
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State | NC
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Zip | 27302-9896
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Country | US
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Telephone | 919-241-8554
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Fax | 336-597-3356
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Authorized Official
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Title or Position | ASSISTANT
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Name | JENNY M POWELL
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Credential |
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Telephone | 336-599-0246
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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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