1083768311 NPI number — C.V. SIKES,JR. & R.B. GOTSCHALK PTR

Table of content: (NPI 1083768311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083768311 NPI number — C.V. SIKES,JR. & R.B. GOTSCHALK PTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C.V. SIKES,JR. & R.B. GOTSCHALK PTR
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:
FAMILY EYE CARE OPTOMETRY
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:
1083768311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1225 CARTHAGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27330-8984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-774-3556
Provider Business Mailing Address Fax Number:
919-774-7356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 CARTHAGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27330-8984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-774-3556
Provider Business Practice Location Address Fax Number:
919-774-7356
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOTSCHALK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
919-774-3556

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1190 , 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: 410024402 . This is a "RR MEDICARE L.SMITH OD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7909036 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7909832 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CF0172 . This is a "RR MEDICARE PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 09713 . This is a "BCBSNC L. SMITH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 410014666 . This is a "RR MEDICARE R.GOTSCHALK" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8909713 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09322 . This is a "BCBSNC R. GOTCHALK" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 410014665 . This is a "RR MEDICARE C. SIKES, JR." identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 09036 . This is a "BCBSNC GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 09832 . This is a "BCBSNC CHARLES SIKES, JR" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8909322 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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