Basic Information
| Provider Information | |||||||||
| NPI: | 1023341088 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW VISION EYECARE OD PA | ||||||||
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| OtherOrganizationName: | TRIANGLE EYE INSTITUTE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3214 CHARLES B ROOT WYND | ||||||||
| Address2: | SUITE 155 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276125440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198810900 | ||||||||
| FaxNumber: | 9198810911 | ||||||||
| Practice Location | |||||||||
| Address1: | 3214 CHARLES B ROOT WYND | ||||||||
| Address2: | SUITE 155 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276125440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198810900 | ||||||||
| FaxNumber: | 9193415273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2009 | ||||||||
| LastUpdateDate: | 10/18/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | SANJAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9192729970 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | O.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 191279 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 022PU | 01 | NC | BLUE CROSS & BLUE SHIELD | OTHER |