Provider Demographics
NPI:1942241898
Name:DVORZSAK, DEVON C (OD)
Entity Type:Individual
Prefix:DR
First Name:DEVON
Middle Name:C
Last Name:DVORZSAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5226 SIGMON RD
Mailing Address - Street 2:ATTN: OPTICAL
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1666
Mailing Address - Country:US
Mailing Address - Phone:910-793-1517
Mailing Address - Fax:910-793-1518
Practice Address - Street 1:5226 SIGMON RD
Practice Address - Street 2:ATTN: OPTICAL
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1666
Practice Address - Country:US
Practice Address - Phone:910-793-1517
Practice Address - Fax:910-793-1518
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1901152W00000X, 152WC0802X, 152WP0200X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093TGOtherBCNS NUMBER
NC89093RAMedicaid
NC2473185Medicare ID - Type UnspecifiedMEDICARE NUMBER
NCU99479Medicare UPIN