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General NPI Number Information
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NPI Number | 1912443755
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Entity Type | Organization
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Legal Business Name | SALEM OPTICAL OUTLET
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Dates
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Enumeration Date | 01/18/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 4310 ENTERPRISE DR SUITE I
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3260
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Country | US
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Telephone | 336-757-1120
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Fax |
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Provider Business Mailing Address
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Address Line | 4310 ENTERPRISE DR SUITE I
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3260
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Country | US
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Telephone | 336-757-1120
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. BILLIE TRADER LITWIN
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Credential |
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Telephone | 336-757-1120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | NC
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