Provider Demographics
NPI:1245370014
Name:WILMINGTON OPTOMETRY, PA
Entity type:Organization
Organization Name:WILMINGTON OPTOMETRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-791-6086
Mailing Address - Street 1:1205 FLORAL PKWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6216
Mailing Address - Country:US
Mailing Address - Phone:910-791-6086
Mailing Address - Fax:910-392-8087
Practice Address - Street 1:1205 FLORAL PKWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6216
Practice Address - Country:US
Practice Address - Phone:910-791-6086
Practice Address - Fax:910-392-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909965Medicaid
NC2339526Medicare PIN
NC5718780001Medicare NSC
NCT65041Medicare UPIN