1164763975 NPI number — TRUEVISION EYE CARE OD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164763975 NPI number — TRUEVISION EYE CARE OD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUEVISION EYE CARE OD 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:
Provider Other Organization Name Type Code:
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:
1164763975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1004 LOWER SHILOH WAY STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27560-5431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-472-4070
Provider Business Mailing Address Fax Number:
919-472-4069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 LOWER SHILOH WAY
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
MORRISVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27560-5426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-263-2499
Provider Business Practice Location Address Fax Number:
919-300-5716
Provider Enumeration Date:
03/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BARNES
Authorized Official First Name:
ALECIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER, OPTOMETRIST
Authorized Official Telephone Number:
919-649-8858

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1644 , 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: 890916X , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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