Provider Demographics
NPI:1932650389
Name:THURMOND EYE CENTER OD PA
Entity Type:Organization
Organization Name:THURMOND EYE CENTER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:THURMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-281-2015
Mailing Address - Street 1:1015 HWY 150 WEST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9198
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 HWY 150 WEST
Practice Address - Street 2:SUITE D
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9198
Practice Address - Country:US
Practice Address - Phone:336-281-2015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890991KMedicaid
NCT93124Medicare UPIN