Basic Information
| Provider Information | |||||||||
| NPI: | 1174737886 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TARBORO CLINIC OPTICAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 CLINIC DR | ||||||||
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| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278861935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528232105 | ||||||||
| FaxNumber: | 2528233164 | ||||||||
| Practice Location | |||||||||
| Address1: | 2807 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278861903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528238295 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 10/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | WEBB | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2528232219 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1077 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.