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General NPI Number Information
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NPI Number | 1972724201
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Entity Type | Organization
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Legal Business Name | ACADEMY EYE CENTER OPTOMETRY, PA
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 1040 RANDOLPH ST SUITE 32
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City | THOMASVILLE
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State | NC
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Zip | 27360-6383
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Country | US
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Telephone | 336-475-0151
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Fax | 336-472-6831
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Provider Business Mailing Address
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Address Line | 213 W NAOMI ST
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City | RANDLEMAN
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State | NC
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Zip | 27317-1733
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Country | US
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Telephone | 336-495-3019
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Fax | 336-495-5703
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | JENNIE MITCHELL
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Credential |
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Telephone | 336-905-9745
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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 | 1464
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License Number State | NC
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