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General NPI Number Information
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NPI Number | 1891108924
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Entity Type | Organization
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Legal Business Name | FOCUS VISION OPTOMETRIC CARE, PLLC
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 1594 SKIBO RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-3478
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Country | US
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Telephone | 336-392-4261
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Fax | 910-867-7539
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Provider Business Mailing Address
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Address Line | 144 BANDANA WAY
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City | CAMERON
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State | NC
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Zip | 28326-4040
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Country | US
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Telephone | 336-392-4261
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. BUPATHI DISSANAYAKE-MUSALEM
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Credential | O.D.
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Telephone | 336-392-4261
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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 | 2308
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License Number State | NC
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