=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841211828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREENVILLE OPTICIANS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 11/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2425A HEMBY LN
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27834-3733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-758-4166
-----------------------------------------------------
Fax | 252-758-5456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2425A HEMBY LN
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27834-3733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-758-4166
-----------------------------------------------------
Fax | 252-758-5456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JANET WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-758-4166
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156F00000X
-----------------------------------------------------
Taxonomy Name | Technician/Technologist
-----------------------------------------------------
License Number | 200001362627
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 200001362627
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------