1184766644 NPI number — C & S OPTOMETRIC SERVICES PLLC

Table of content: (NPI 1184766644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184766644 NPI number — C & S OPTOMETRIC SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C & S OPTOMETRIC SERVICES PLLC
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:
1184766644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 219
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLIANCE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28509-0219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-745-4100
Provider Business Mailing Address Fax Number:
252-745-3909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13820 HWY 55 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLIANCE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28509-0219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-745-4100
Provider Business Practice Location Address Fax Number:
252-745-3909
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOTY
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGING CO-OWNER
Authorized Official Telephone Number:
252-745-4100

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0203C . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890203C , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y1890 . This is a "BLIND COMMISSION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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