Provider Demographics
NPI:1235353541
Name:VALERIE A. COLBORN, O.D., P.A.
Entity Type:Organization
Organization Name:VALERIE A. COLBORN, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COLBORN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-893-4141
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:1023 S. MAIN STREET
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-0096
Mailing Address - Country:US
Mailing Address - Phone:910-893-4141
Mailing Address - Fax:
Practice Address - Street 1:1023 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-0096
Practice Address - Country:US
Practice Address - Phone:910-893-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0912POtherBCBS
NC890902NMedicaid
NC890902NMedicaid
NC1276440001Medicare NSC
NC0912POtherBCBS