MEDICARE: DR. DARREN C. DECKER O.D.

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	2058	NC

General Provider Information

NPI Number	:	1982890398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARREN C. DECKER O.D.

Provider Business Mailing Address
First Line	:	2630 PETERS CREEK PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-5655
Country	:	US
Telephone Number	:	336-785-3486
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 PETERS CREEK PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-5655
Country	:	US
Telephone Number	:	336-785-3486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/19/2007

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