1922094895 NPI number — MEDICAL EYE ASSOCIATES PA

Table of content: (NPI 1922094895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922094895 NPI number — MEDICAL EYE ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL EYE ASSOCIATES PA
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:
WILSON OPTICAL
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:
1922094895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1707 MEDICAL PARK DR W
Provider Second Line Business Mailing Address:
STE1
Provider Business Mailing Address City Name:
WILSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27893-2768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-291-7008
Provider Business Mailing Address Fax Number:
252-291-1281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1707 MEDICAL PARK DR W
Provider Second Line Business Practice Location Address:
STE1
Provider Business Practice Location Address City Name:
WILSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27893-2768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-291-7008
Provider Business Practice Location Address Fax Number:
252-291-1281
Provider Enumeration Date:
09/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PUTNAM
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PARTNER/PRESIDENT
Authorized Official Telephone Number:
252-443-6129

Provider Taxonomy Codes

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

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

  • Identifier: 180044388 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180641778 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180041942 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1180L . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180041781 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1073659769 . This is a "NPI JOHN E THORDSEN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 22680 . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 190041779 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00720248 . This is a "RAILROAD MCEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 37986 . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1093V . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12630 . This is a "BC" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com