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General NPI Number Information
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NPI Number | 1962605105
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Entity Type | Organization
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Legal Business Name | SUSAN C WHITAKER OD PA
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 101 MONROE PL
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City | CARTHAGE
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State | NC
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Zip | 28327-9784
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Country | US
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Telephone | 910-947-7740
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Fax | 910-947-7742
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Provider Business Mailing Address
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Address Line | PO BOX 875
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City | CARTHAGE
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State | NC
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Zip | 28327-0875
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Country | US
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Telephone | 910-947-7740
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Fax | 910-947-7742
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Authorized Official
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Title or Position | OPTOMETIST
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Name | SUSAN C BAILEY
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Credential | OD
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Telephone | 910-947-7740
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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 | NC1253
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License Number State | NC
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