1861465205 NPI number — CAROLINA EYE PROSTHETICS, INC.

Table of content: (NPI 1861465205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861465205 NPI number — CAROLINA EYE PROSTHETICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA EYE PROSTHETICS, INC.
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:
1861465205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27215-5934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-228-7877
Provider Business Mailing Address Fax Number:
336-228-7514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27215-5934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-228-7877
Provider Business Practice Location Address Fax Number:
336-228-7514
Provider Enumeration Date:
02/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JEFFERSON
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
BOYD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
336-228-7877

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X , with the licence number: 335E00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0494I . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7704513 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".