Basic Information
| Provider Information | |||||||||
| NPI: | 1912168386 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MODERN EYE CARE OF SALISBURY OD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 FAITH RD | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281467005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046377727 | ||||||||
| FaxNumber: | 7046364284 | ||||||||
| Practice Location | |||||||||
| Address1: | 223 FAITH RD | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281467005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046377728 | ||||||||
| FaxNumber: | 7046364284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2008 | ||||||||
| LastUpdateDate: | 01/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | REECE | ||||||||
| AuthorizedOfficialFirstName: | DUSTIN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OD OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7046377728 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD FAAO | ||||||||
| NPICertificationDate: | |||||||||
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.