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General NPI Number Information
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NPI Number | 1609135144
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Entity Type | Organization
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Legal Business Name | GREENSBORO OPTOMETRIC, PA
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Dates
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Enumeration Date | 05/03/2012
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Last Update Date | 05/03/2012
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Provider Practice Location Address
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Address Line | 226 S ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-2692
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Country | US
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Telephone | 336-722-5346
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Fax | 336-722-5348
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Provider Business Mailing Address
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Address Line | 226 S ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-2692
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Country | US
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Telephone | 336-722-5346
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Fax | 336-722-5348
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Authorized Official
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Title or Position | MANAGER
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Name | MR. CALVIN PRESNELL
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Credential |
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Telephone | 336-722-5346
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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 | 1778
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License Number State | NC
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