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General NPI Number Information
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NPI Number | 1821239971
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Entity Type | Organization
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Legal Business Name | PEDIATRIC OPHTHALMOLOGY ASSOCIATES, P.A.
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 2519 OAKCREST AVE
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City | GREENSBORO
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State | NC
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Zip | 27408-4707
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Country | US
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Telephone | 336-271-2007
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Fax | 336-271-2904
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Provider Business Mailing Address
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Address Line | 2519 OAKCREST AVE
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City | GREENSBORO
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State | NC
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Zip | 27408-4707
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Country | US
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Telephone | 336-271-2007
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Fax | 336-271-2904
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM O YOUNG
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Credential | M.D.
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Telephone | 336-271-2007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 2009-00114
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License Number State | NC
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