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General NPI Number Information
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NPI Number | 1609675396
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Entity Type | Individual
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Provider Name | SUSAN BAILEY TRADER LICENSED OPTICIAN
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Gender | Female
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 4310 ENTERPRISE DR STE I
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3260
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Country | US
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Telephone | 336-757-1120
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Fax | 336-757-1202
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Provider Business Mailing Address
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Address Line | 4310 ENTERPRISE DR STE I
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3260
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Country | US
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Telephone | 336-757-1120
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Fax | 336-757-1202
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | 1638
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License Number State | NC
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