| NPI | 1245737568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLY LYNN FULLER Owner 336-448-3060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: NC 2015-01115) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: NC 2015-01115) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2019-04-05 |