Provider Demographics
NPI:1760120729
Name:SLYCORD, AMY LYNN (LDO)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:SLYCORD
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W KING ST
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3344
Mailing Address - Country:US
Mailing Address - Phone:704-750-6164
Mailing Address - Fax:704-750-3653
Practice Address - Street 1:316 W KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3344
Practice Address - Country:US
Practice Address - Phone:704-750-6164
Practice Address - Fax:704-750-3653
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician