1003982414 NPI number — EYE MEDICS OPTOMETRY PA

Table of content: (NPI 1003982414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003982414 NPI number — EYE MEDICS OPTOMETRY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE MEDICS 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:
Provider Other Organization Name Type Code:
6
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:
1003982414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6970 NEXUS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28304-2642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-426-3937
Provider Business Mailing Address Fax Number:
888-526-1583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6970 NEXUS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28304-2642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-426-3937
Provider Business Practice Location Address Fax Number:
888-526-1583
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SINGLETARY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
910-426-3937

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1921 , 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: 017F2 . This is a "GROUP BLUE CROSS BLUE SHI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5902566 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700885357 . This is a "NPI DR. EVA S. SINGLETARY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5902565 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215936885 . This is a "NPI DR. JAMES SINGLETARY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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