1669780862 NPI number — MRS. LINDSAY SCHAFER STATSICK OD

Table of content: MRS. LINDSAY SCHAFER STATSICK OD (NPI 1669780862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669780862 NPI number — MRS. LINDSAY SCHAFER STATSICK OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STATSICK
Provider First Name:
LINDSAY
Provider Middle Name:
SCHAFER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHAFER
Provider Other First Name:
LINDSAY
Provider Other Middle Name:
RACHEL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669780862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ATLANTIC EYE OPTOMETRIC SERVICES, PA
Provider Second Line Business Mailing Address:
2803 CASHWELL DR SUITE A
Provider Business Mailing Address City Name:
GOLDSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27534-4301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-778-2015
Provider Business Mailing Address Fax Number:
919-778-4808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ATLANTIC EYE OPTOMETRIC SERVICES, PA
Provider Second Line Business Practice Location Address:
2803 CASHWELL DR SUITE A
Provider Business Practice Location Address City Name:
GOLDSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27534-4301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-778-2015
Provider Business Practice Location Address Fax Number:
919-778-4808
Provider Enumeration Date:
09/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2211 , 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)





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