MEDICARE: DUPLIN EYE ASSOCIATES 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

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	:	1508845587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUPLIN EYE ASSOCIATES PA

Provider Business Mailing Address
First Line	:	PO BOX 486
Second Line	:
City	:	KENANSVILLE
State	:	NC
Zip	:	28349-0486
Country	:	US
Telephone Number	:	910-296-1781
Fax Number	:	910-296-1843

Provider Business Practice Location Address
First Line	:	402 N MAIN ST
Second Line	:
City	:	KENANSVILLE
State	:	NC
Zip	:	28349-8801
Country	:	US
Telephone Number	:	910-296-1781
Fax Number	:	910-296-1843

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. GAIL STROUD TERRY
Credential	:
Telephone Number	:	910-296-1781

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	02/10/2020

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Directions to “DUPLIN EYE ASSOCIATES PA ” Practice Location

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