Provider Demographics
NPI:1821239971
Name:PEDIATRIC OPHTHALMOLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:PEDIATRIC OPHTHALMOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-271-2007
Mailing Address - Street 1:2519 OAKCREST AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4707
Mailing Address - Country:US
Mailing Address - Phone:336-271-2007
Mailing Address - Fax:336-271-2904
Practice Address - Street 1:2519 OAKCREST AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4707
Practice Address - Country:US
Practice Address - Phone:336-271-2007
Practice Address - Fax:336-271-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00114207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty