1548439839 NPI number — INVISION FAMILY EYECARE OD PLLC

Table of content: (NPI 1548439839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548439839 NPI number — INVISION FAMILY EYECARE OD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INVISION FAMILY EYECARE OD PLLC
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:
INVISION FAMILY EYECARE
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:
1548439839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6167 BAYFIELD PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28027-7486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-795-3937
Provider Business Mailing Address Fax Number:
704-795-1577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6167 BAYFIELD PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28027-7486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-795-3937
Provider Business Practice Location Address Fax Number:
704-795-1577
Provider Enumeration Date:
02/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVID
Authorized Official First Name:
LASHETA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
ORGANIZING MEMBER
Authorized Official Telephone Number:
704-795-3937

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1647 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 093H3 . This is a "BCBS OF NC STATE HEALTH CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 093H3 . This is a "BLUE CROSS BLUE SHIELD OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890915N , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".