MEDICARE: WILMINGTON OPTOMETRY, PA

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	1234	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	:	1245370014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILMINGTON OPTOMETRY, PA

Provider Business Mailing Address
First Line	:	1205 FLORAL PKWY
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6216
Country	:	US
Telephone Number	:	910-791-6086
Fax Number	:	910-392-8087

Provider Business Practice Location Address
First Line	:	1205 FLORAL PKWY
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6216
Country	:	US
Telephone Number	:	910-791-6086
Fax Number	:	910-392-8087

Authorized Official
Title or Position	:	OWNER
Name	:	EDWARD WEAVER
Credential	:	OD
Telephone Number	:	910-791-6086

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	02/26/2008

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Directions to “WILMINGTON OPTOMETRY, PA ” Practice Location

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