Private Diagnostic Clinic, PLLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

PRIVATE DIAGNOSTIC CLINIC, PLLC

Practice address

2025 Frontis Plaza Blvd
Suite 100
Winston Salem, NC 27103-5663

Phone

(336) 768-3240

NPI assigned

Sep 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christopher Thomas Frederick

Title

Cfo

Phone

(919) 613-7762

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Duke Eye Winston Salem Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657497600000",
    "number": "1992802128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110566",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277095566",
            "telephone_number": "919-620-4855",
            "fax_number": "919-620-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 FRONTIS PLAZA BLVD",
            "address_2": "SUITE 100",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035663",
            "telephone_number": "336-768-3240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVATE DIAGNOSTIC CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "919-613-7762"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902034",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Duke Eye Winston Salem",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Duke Eye Winston Salem",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Ophthalmology Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Ophthalmology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.