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General NPI Number Information
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NPI Number | 1932353976
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Entity Type | Organization
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Legal Business Name | YADKIN VISION CENTER O.D., PLLC
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 115 PAULINE ST
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City | EAST BEND
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State | NC
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Zip | 27018-7686
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Country | US
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Telephone | 336-699-8170
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Fax | 336-699-8162
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Provider Business Mailing Address
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Address Line | 115 PAULINE ST
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City | EAST BEND
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State | NC
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Zip | 27018-7686
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Country | US
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Telephone | 336-699-8170
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Fax | 336-699-8162
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | DR. SCOTT GORDON
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Credential | O.D.
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Telephone | 336-679-2931
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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 |
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License Number State |
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