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General NPI Number Information
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NPI Number | 1750512414
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Entity Type | Organization
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Legal Business Name | CONRAD FAULKNER OD PA
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 834 HARDEE RD VERNON PARK MALL
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City | KINSTON
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State | NC
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Zip | 28504-3360
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Country | US
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Telephone | 252-559-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 7395 US HIGHWAY 70 W
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City | LA GRANGE
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State | NC
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Zip | 28551-8211
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Country | US
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Telephone | 252-566-4583
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JAMES C FAULKNER
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Credential |
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Telephone | 252-566-4583
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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 | 0758
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License Number State | NC
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