Provider Demographics
NPI:1932353976
Name:YADKIN VISION CENTER O.D., PLLC
Entity Type:Organization
Organization Name:YADKIN VISION CENTER O.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-679-2931
Mailing Address - Street 1:115 PAULINE ST
Mailing Address - Street 2:
Mailing Address - City:EAST BEND
Mailing Address - State:NC
Mailing Address - Zip Code:27018-7686
Mailing Address - Country:US
Mailing Address - Phone:336-699-8170
Mailing Address - Fax:336-699-8162
Practice Address - Street 1:115 PAULINE ST
Practice Address - Street 2:
Practice Address - City:EAST BEND
Practice Address - State:NC
Practice Address - Zip Code:27018-7686
Practice Address - Country:US
Practice Address - Phone:336-699-8170
Practice Address - Fax:336-699-8162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950715Medicaid
6224520002Medicare NSC
2335860AMedicare PIN