1528352663 NPI number — EYE CARE ASSOCIATES, OD PA

Table of content: (NPI 1528352663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528352663 NPI number — EYE CARE ASSOCIATES, OD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CARE ASSOCIATES, 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:
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:
1528352663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 SIX FORKS RD
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27615-6156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-847-0187
Provider Business Mailing Address Fax Number:
919-676-2231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7075 WHITE OAK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27529-9194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-282-0053
Provider Business Practice Location Address Fax Number:
919-282-0057
Provider Enumeration Date:
06/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BOLICK
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER, CEO
Authorized Official Telephone Number:
919-847-0187

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: 5917896 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 024VH . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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