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General NPI Number Information
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NPI Number | 1689855223
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Entity Type | Organization
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Legal Business Name | ROSCOE OPTOMETRIC CLINIC PA
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 420 W MAIN ST
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City | SANFORD
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State | NC
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Zip | 27332-5924
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Country | US
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Telephone | 919-776-2712
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Fax | 919-775-3486
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Provider Business Mailing Address
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Address Line | PO BOX 3517
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City | SANFORD
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State | NC
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Zip | 27331-3517
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Country | US
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Telephone | 919-776-2712
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Fax | 919-775-3486
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. WILLIAM DOUGLAS ROSCOE
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Credential | O.D.
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Telephone | 919-776-2712
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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 | 0969
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0969
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License Number State | NC
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