Provider Demographics
NPI:1992859847
Name:OVERMAN, GEORGE ANDERSON (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ANDERSON
Last Name:OVERMAN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 N ROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3334
Mailing Address - Country:US
Mailing Address - Phone:252-331-7922
Mailing Address - Fax:252-331-2111
Practice Address - Street 1:1125 N ROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3334
Practice Address - Country:US
Practice Address - Phone:252-331-7922
Practice Address - Fax:252-331-2111
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC615156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8801974Medicaid
NC8801974Medicaid