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General NPI Number Information
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NPI Number | 1649394891
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Entity Type | Organization
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Legal Business Name | EYEWEAR UNLIMITED OPTICAL SHOP
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 224 TOWN RUN LN
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City | WINSTON SALEM
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State | NC
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Zip | 27101-3911
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Country | US
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Telephone | 336-723-0748
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Fax | 336-721-4711
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Provider Business Mailing Address
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Address Line | 224 TOWN RUN LN
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City | WINSTON SALEM
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State | NC
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Zip | 27101-3911
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Country | US
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Telephone | 336-723-0748
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Fax | 336-721-4711
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Authorized Official
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Title or Position | OWNER
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Name | JAMES DAVID BRANCH
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Credential | MD
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Telephone | 336-723-0748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 21915
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License Number State | NC
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