Provider Demographics
NPI:1649437807
Name:CONNER, FRED B JR (LISENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:B
Last Name:CONNER
Suffix:JR
Gender:M
Credentials:LISENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 MARTIN LUTHER KING BLVD.
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514
Mailing Address - Country:US
Mailing Address - Phone:919-969-9667
Mailing Address - Fax:919-969-9774
Practice Address - Street 1:1816 MARTIN LUTHER KING JR. BLVD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-969-9667
Practice Address - Fax:919-969-9774
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC0348156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician