1710323803 NPI number — EYE CARE ASSOCIATES OD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710323803 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:
1710323803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2013
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:
27615-6260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-847-0187
Provider Business Mailing Address Fax Number:
919-863-2862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2013 OLDE REGENT WAY
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
LELAND
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28451-4193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-782-1883
Provider Business Practice Location Address Fax Number:
910-782-1884
Provider Enumeration Date:
05/15/2013

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , 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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