Myrtle Grove Optical, LLC
Eyewear Supplier (Equipment, not the service) in Wilmington, NC. Organization (NPI-2).
NPI number1972716645
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1972716645
- Entity type
- Organization (NPI-2)
- Legal business name
- Myrtle Grove Optical, LLC
- Organization subpart
- No
- Enumeration date
- May 8, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 332H00000X | Eyewear Supplier (Equipment, not the service) | 0735 | NC | Yes |
Practice location
1917 Tradd CtWilmington, NC 28401-6638
Phone 910-762-2300
Mailing address
1917 Tradd CtWilmington, NC 28401-6638
Phone 910-762-2300
Authorized official
Timothy G. Kelly
Owner
9107622300
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