Provider Demographics
NPI:1629528104
Name:OLIVER OPTOMETRIC EYE CARE
Entity Type:Organization
Organization Name:OLIVER OPTOMETRIC EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-372-4493
Mailing Address - Street 1:PO BOX 1119
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-1119
Mailing Address - Country:US
Mailing Address - Phone:336-372-4493
Mailing Address - Fax:336-372-2035
Practice Address - Street 1:18 GRAYSON ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-6006
Practice Address - Country:US
Practice Address - Phone:336-372-4493
Practice Address - Fax:336-372-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2461152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty