MEDICARE: YADKIN VISION CENTER, OD 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	1264	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	:	1568402741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YADKIN VISION CENTER, OD PA

Provider Business Mailing Address
First Line	:	PO BOX 686
Second Line	:
City	:	EAST BEND
State	:	NC
Zip	:	27018-0686
Country	:	US
Telephone Number	:	336-699-8170
Fax Number	:	336-699-8162

Provider Business Practice Location Address
First Line	:	517 HWY 67 BYPASS
Second Line	:
City	:	EAST BEND
State	:	NC
Zip	:	27018
Country	:	US
Telephone Number	:	336-699-8170
Fax Number	:	336-699-8162

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRETT H. MUNN
Credential	:	OD
Telephone Number	:	336-699-8170

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	03/07/2008

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