Street, Dexter Wayne

Street, Dexter Wayne is an individual health care provider with primary practice located at 913 Worth St , Mount Airy NC 27030-4459. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Street, Dexter Wayne can be contacted via phone (336) 786-8828.

Contact Information

Primary practice address
913 Worth St Mount Airy NC 27030-4459
Phone: (336) 786-8828
Fax: (336) 786-5977
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1375 North Carolina

Profile Details

NPI number 1962464156
LBN Legal business name Street, Dexter Wayne
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 4th, 2006
Last updated Nov 30th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962464156 NPPES
Virginia Other 431657 ANTHEM
Virginia Other 09878 ANTHEM
Virginia MEDICAID 7909878 ANTHEM
Virginia Other 410038739 ANTHEM
Virginia Other 2208005 ANTHEM

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