Provider Demographics
NPI:1609135144
Name:GREENSBORO OPTOMETRIC, PA
Entity Type:Organization
Organization Name:GREENSBORO OPTOMETRIC, PA
Other - Org Name:OSCAR OGLETHORPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-722-5346
Mailing Address - Street 1:226 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2692
Mailing Address - Country:US
Mailing Address - Phone:336-722-5346
Mailing Address - Fax:336-722-5348
Practice Address - Street 1:226 S ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2692
Practice Address - Country:US
Practice Address - Phone:336-722-5346
Practice Address - Fax:336-722-5348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1778152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2471708Medicare UPIN