Provider Demographics
NPI:1962521690
Name:THURMOND EYE ASSOCIATES OD, PA
Entity type:Organization
Organization Name:THURMOND EYE ASSOCIATES OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SHERMAN
Authorized Official - Last Name:THURMOND
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:336-226-7357
Mailing Address - Street 1:310 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-3711
Mailing Address - Country:US
Mailing Address - Phone:336-226-7357
Mailing Address - Fax:336-227-8119
Practice Address - Street 1:310 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3711
Practice Address - Country:US
Practice Address - Phone:336-226-7357
Practice Address - Fax:336-227-8119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1402261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890991KMedicaid
NC2468079CMedicare ID - Type Unspecified
NC5026580001Medicare NSC
NC890991KMedicaid
NCT93124Medicare UPIN