Provider Demographics
NPI:1689622888
Name:MOTSINGER, PERRY C (OD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:C
Last Name:MOTSINGER
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 1:205 US HIGHWAY 117 S
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-6704
Mailing Address - Country:US
Mailing Address - Phone:910-259-9230
Mailing Address - Fax:910-259-9215
Practice Address - Street 1:205 US HIGHWAY 117 S
Practice Address - Street 2:SUITE 4
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-6704
Practice Address - Country:US
Practice Address - Phone:910-259-9230
Practice Address - Fax:910-259-9215
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093P4Medicaid
NC5117970001Medicare NSC
NCU92769Medicare UPIN
NC2337629Medicare ID - Type UnspecifiedGROUP #
NC2472241CMedicare ID - Type UnspecifiedINDIVIDUAL #