Provider Demographics
NPI:1215184858
Name:GURLEY, AMY THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:THOMAS
Last Name:GURLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 ROBINHOOD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-9820
Mailing Address - Country:US
Mailing Address - Phone:336-924-9121
Mailing Address - Fax:336-924-6215
Practice Address - Street 1:5305 ROBINHOOD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-9820
Practice Address - Country:US
Practice Address - Phone:336-924-9121
Practice Address - Fax:336-924-6215
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950461Medicaid
6451120001Medicare NSC
NC247079313Medicare PIN