Provider Demographics
NPI:1518989607
Name:COLBORN, VALERIE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:ANN
Last Name:COLBORN
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: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
Practice Address - Country:US
Practice Address - Phone:910-893-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1473152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0912POtherBCBS
NC1276440001OtherPALMETTO
NC890902NMedicaid
NCMC0127224OtherDEA
NC1276440001OtherPALMETTO
NC890902NMedicaid