MEDICARE: CRAVEN OPTOMETRIC CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0822	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184899619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAVEN OPTOMETRIC CENTER

Provider Business Mailing Address
First Line	:	3005 DR MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5211
Country	:	US
Telephone Number	:	252-633-0651
Fax Number	:	252-514-9419

Provider Business Practice Location Address
First Line	:	3005 DR MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5211
Country	:	US
Telephone Number	:	252-633-0651
Fax Number	:	252-514-9419

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VIRGIL HYMAN MEWBORN III
Credential	:	O.D.
Telephone Number	:	252-633-0651

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	04/25/2008

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Directions to “CRAVEN OPTOMETRIC CENTER ” Practice Location

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