Provider Demographics
NPI:1336150093
Name:PAYNE, DANNY J (OD)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:J
Last Name:PAYNE
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:PO BOX 988
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-0988
Mailing Address - Country:US
Mailing Address - Phone:336-838-5852
Mailing Address - Fax:
Practice Address - Street 1:525 W PARK CIR
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3548
Practice Address - Country:US
Practice Address - Phone:336-838-5852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC992152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909697Medicaid
NC246320Medicare PIN
NC8909697Medicaid
NCT64864Medicare UPIN