Provider Demographics
NPI:1154456143
Name:JEFFREY L. TAYLOR OD AND LYNN C. TAYLOR OD, PA
Entity type:Organization
Organization Name:JEFFREY L. TAYLOR OD AND LYNN C. TAYLOR OD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-837-1000
Mailing Address - Street 1:4295 E US 64 ALT
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-6847
Mailing Address - Country:US
Mailing Address - Phone:828-837-1000
Mailing Address - Fax:828-837-1100
Practice Address - Street 1:4295 E US 64 ALT
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6847
Practice Address - Country:US
Practice Address - Phone:828-837-1000
Practice Address - Fax:828-837-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1592152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCH4108OtherRAILROAD MEDICARE
NCDC5015OtherRAILROAD MEDICARE
NC890208WMedicaid
NCU61815Medicare UPIN
NC2471316Medicare ID - Type Unspecified
NC890208WMedicaid