Basic Information
| Provider Information | |||||||||
| NPI: | 1598051914 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRESSON & MCKEEL OPTOMETRIC GROUP PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DOCTORS VISION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4252 ARENDELL ST | ||||||||
| Address2: | SUITE G | ||||||||
| City: | MOREHEAD CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285572866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522223090 | ||||||||
| FaxNumber: | 2522223091 | ||||||||
| Practice Location | |||||||||
| Address1: | 4252 ARENDELL ST | ||||||||
| Address2: | SUITE G | ||||||||
| City: | MOREHEAD CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285572866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526332901 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2011 | ||||||||
| LastUpdateDate: | 11/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | PRESSON | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2522223090 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 5918091 | 05 | NC | MEDICAID |