1588704340 NPI number — CARY EYE CENTER OPTOMETRY PA

Table of content: (NPI 1588704340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588704340 NPI number — CARY EYE CENTER OPTOMETRY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARY EYE CENTER 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:
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:
1588704340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1398 KILDAIRE FARM RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27511-5567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-467-3238
Provider Business Mailing Address Fax Number:
919-460-7776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1398 KILDAIRE FARM RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27511-5567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-467-3238
Provider Business Practice Location Address Fax Number:
919-460-7776
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DURHAM
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
LICATA
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
919-467-3238

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  1335 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WL0500X , with the licence number: 1335 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: 1335 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X , with the licence number: 1335 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X , with the licence number: 1335 , 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: 083568695 . This is a "TRICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 410036278 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0917N . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 543199 . This is a "MAMSI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5910 . This is a "AVESIS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2253547 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890971N , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: B729 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NC9335 . This is a "VBA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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