Provider Demographics
NPI:1790874329
Name:GUILFORD EYE CENTER OD PA
Entity Type:Organization
Organization Name:GUILFORD EYE CENTER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:THURMOND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-292-4516
Mailing Address - Street 1:5500 W FRIENDLY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4368
Mailing Address - Country:US
Mailing Address - Phone:336-292-4516
Mailing Address - Fax:336-292-5706
Practice Address - Street 1:5500 W FRIENDLY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4368
Practice Address - Country:US
Practice Address - Phone:336-292-4516
Practice Address - Fax:336-292-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC690129CMedicaid
NC690129CMedicaid
NC5216020001Medicare NSC