1578514527 NPI number — CENTRAL CAROLINA ASSOCIATES IN OPTOMETRY 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 1578514527 NPI number — CENTRAL CAROLINA ASSOCIATES IN OPTOMETRY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL CAROLINA ASSOCIATES IN OPTOMETRY 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:
THE EYECARE GROUP
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:
1578514527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 E CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27292-4112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-249-8901
Provider Business Mailing Address Fax Number:
336-248-2695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1402 EASTCHESTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27265-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-886-8400
Provider Business Practice Location Address Fax Number:
336-886-1800
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOWAL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
336-249-8901

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 890918C , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com