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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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