Provider Demographics
NPI:1558327379
Name:PEDIATRIC OPTHALMOLOGY ASSOC PA
Entity Type:Organization
Organization Name:PEDIATRIC OPTHALMOLOGY ASSOC PA
Other - Org Name:KIDSPECS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-271-2007
Mailing Address - Street 1:1305 C WEST WENDOVER AVENUE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8124
Mailing Address - Country:US
Mailing Address - Phone:336-271-2007
Mailing Address - Fax:336-271-2904
Practice Address - Street 1:1305 C WEST WENDOVER AVENUE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8124
Practice Address - Country:US
Practice Address - Phone:336-271-2007
Practice Address - Fax:336-271-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty