Provider Demographics
NPI:1043901093
Name:BRITT, AUDREY GAIL (LDO)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:GAIL
Last Name:BRITT
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-0772
Mailing Address - Country:US
Mailing Address - Phone:336-246-3513
Mailing Address - Fax:336-246-3852
Practice Address - Street 1:1489 MOUNT JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-8336
Practice Address - Country:US
Practice Address - Phone:336-246-3513
Practice Address - Fax:336-246-3852
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
TNDPO0000003360156FX1800X
NC832156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician