Provider Demographics
NPI:1497925796
Name:DR. DANNY J. PAYNE
Entity Type:Organization
Organization Name:DR. DANNY J. PAYNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-838-5852
Mailing Address - Street 1:PO BOX 988
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-0988
Mailing Address - Country:US
Mailing Address - Phone:336-838-5852
Mailing Address - Fax:336-838-8798
Practice Address - Street 1:625 W PARK CIR
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3550
Practice Address - Country:US
Practice Address - Phone:336-838-5852
Practice Address - Fax:336-838-8798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC992332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909697Medicaid
NCT64864Medicare UPIN
NC246320Medicare PIN
NC8909697Medicaid