MEDICARE: DR JOANN TODD & ASSOCIATES OF OPTOMETRY, PLLC

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	2138	NC

General Provider Information

NPI Number	:	1992044473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR JOANN TODD & ASSOCIATES OF OPTOMETRY, PLLC

Provider Business Mailing Address
First Line	:	1122 N BREAZEALE AVE
Second Line	:
City	:	MOUNT OLIVE
State	:	NC
Zip	:	28365-1121
Country	:	US
Telephone Number	:	919-658-2020
Fax Number	:	919-658-0487

Provider Business Practice Location Address
First Line	:	1122 N BREAZEALE AVE
Second Line	:
City	:	MOUNT OLIVE
State	:	NC
Zip	:	28365-1121
Country	:	US
Telephone Number	:	919-658-2020
Fax Number	:	919-658-0487

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOANN TODD
Credential	:	OD
Telephone Number	:	919-658-2020

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	05/28/2013

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