Basic Information
| Provider Information | |||||||||
| NPI: | 1003148727 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RS EYE CARE, OD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5237 SUNSET LAKE ROAD | ||||||||
| Address2: | |||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193034445 | ||||||||
| FaxNumber: | 9199348154 | ||||||||
| Practice Location | |||||||||
| Address1: | 5237 SUNSET LAKE ROAD | ||||||||
| Address2: | |||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193034445 | ||||||||
| FaxNumber: | 9199348154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2010 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | STOCKBRIDGE | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 3157945751 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | 05/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 5916190 | 05 | NC | MEDICAID | 89093M7 | 05 | NC | MEDICAID |