1265587828 NPI number — CAROLINA EYE ASSOCIATES INC

Table of content: (NPI 1265587828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265587828 NPI number — CAROLINA EYE ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA EYE ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CAROLINA EYE ASSOCIATES PA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265587828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2170 MIDLAND RD STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHERN PINES
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28387-2927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-295-2100
Provider Business Mailing Address Fax Number:
910-295-3625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1991 FORDHAM DR
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28304-3773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-485-2020
Provider Business Practice Location Address Fax Number:
910-485-7571
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
APPLE
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
910-295-2100

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01199 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5950279 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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