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General NPI Number Information
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NPI Number | 1831103753
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Entity Type | Organization
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Legal Business Name | EYE ASSOCIATES OF ROWAN PA
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 800 W CEMETARY ST
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City | SALISBURY
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State | NC
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Zip | 28144-3212
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Country | US
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Telephone | 704-633-0345
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Fax | 704-636-4981
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Provider Business Mailing Address
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Address Line | 800 W CEMETARY ST
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City | SALISBURY
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State | NC
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Zip | 28144-3212
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Country | US
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Telephone | 704-633-0345
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Fax | 704-636-4981
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DONALD BERGSMA
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Credential | M.D.
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Telephone | 704-633-0345
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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 | 9800469
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License Number State | NC
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