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General NPI Number Information
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NPI Number | 1790731305
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Entity Type | Organization
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Legal Business Name | YADKIN VISION CENTER, OD PA
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 902 W MAIN ST
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City | YADKINVILLE
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State | NC
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Zip | 27055-7807
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Country | US
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Telephone | 336-679-2931
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Fax | 336-677-6486
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Provider Business Mailing Address
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Address Line | PO BOX 1757
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City | YADKINVILLE
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State | NC
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Zip | 27055-1757
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Country | US
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Telephone | 336-679-2931
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Fax | 336-677-6486
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRETT H. MUNN
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Credential | OD
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Telephone | 336-679-2931
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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 | 1264
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License Number State | NC
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