Provider Demographics
NPI:1811947567
Name:DOUB, JAMES KENT (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KENT
Last Name:DOUB
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3316 SILAS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3011
Mailing Address - Country:US
Mailing Address - Phone:336-765-5350
Mailing Address - Fax:
Practice Address - Street 1:3316 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3011
Practice Address - Country:US
Practice Address - Phone:336-765-5350
Practice Address - Fax:336-983-3913
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1330152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909238Medicaid
NCP00944987OtherRAILROAD MEDICARE
NCP00944987OtherRAILROAD MEDICARE