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General NPI Number Information
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NPI Number | 1972828838
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL OPTICIANS, LLC
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 04/05/2010
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Provider Practice Location Address
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Address Line | 5000 S CROATAN HWY
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City | NAGS HEAD
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State | NC
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Zip | 27959-8500
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Country | US
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Telephone | 252-441-6353
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1088
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City | NAGS HEAD
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State | NC
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Zip | 27959-1088
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Country | US
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Telephone | 252-441-6353
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTICIAN
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Name | MARY C MAXWELL
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Credential |
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Telephone | 252-441-6353
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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 | 1048
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License Number State | NC
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