Basic Information
| Provider Information | |||||||||
| NPI: | 1194009605 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TARBORO EYE ASSOCIATES OD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4001 | ||||||||
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| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278866001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2807 N MAIN ST | ||||||||
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| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278861903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528238295 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2011 | ||||||||
| LastUpdateDate: | 12/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2528238295 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.