1164763975 NPI number — TRUEVISION EYE CARE OD PA

Table of content: (NPI 1164763975)

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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