1770764946 NPI number — FIRST CHOICE EYE CARE, OD, PLLC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770764946 NPI number — FIRST CHOICE EYE CARE, OD, PLLC

Employer Identification Number (EIN):

Provider Organization Name:

FIRST CHOICE EYE CARE, OD, 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 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:

1770764946

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

08/07/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

14617 LAWYERS RD

Provider Second Line Business Mailing Address:

SUITE A

Provider Business Mailing Address City Name:

MATTHEWS

Provider Business Mailing Address State Name:

NC

Provider Business Mailing Address Postal Code:

28104-3219

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

704-893-0090

Provider Business Mailing Address Fax Number:

704-893-0944

Provider First Line Business Practice Location Address:

14617 LAWYERS RD

Provider Second Line Business Practice Location Address:

SUITE A

Provider Business Practice Location Address City Name:

MATTHEWS

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

28104-3219

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

704-893-0090

Provider Business Practice Location Address Fax Number:

704-893-0944

Provider Enumeration Date:

11/16/2007

Authorized Official Last Name:

BIGHAM

Authorized Official First Name:

KEVIN

Authorized Official Middle Name:

D

Authorized Official Title or Position:

OPTOMETRIST

Authorized Official Telephone Number:

704-893-0090

• Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 152WC0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 152WV0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 890925E , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 803877 . This is a "COMMUNITY EYE" identifier . This identifiers is of the category "OTHER".
• Identifier: 90703 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: 0925E . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: B9267 . This is a "MEDCOST PREFERRED" identifier . This identifiers is of the category "OTHER".
• Identifier: DD2824 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 22.00365 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: B9267 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
• Identifier: 24119 . This is a "AVESIS" identifier . This identifiers is of the category "OTHER".
• Identifier: 68011 . This is a "BEACHSTREET" identifier . This identifiers is of the category "OTHER".
• Identifier: 803877 . This is a "PARTNERS MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: ND1746 . This is a "VISION BENEFITS OF AMERIC" identifier . This identifiers is of the category "OTHER".