Basic Information
| Provider Information | |||||||||
| NPI: | 1568796068 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OASIS EYE CARE OPTOMETRY P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1309 | ||||||||
| Address2: | |||||||||
| City: | DUNN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283351309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108917777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26 TECHNOLOGY DR | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275297945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196617776 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2009 | ||||||||
| LastUpdateDate: | 08/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | SAID | ||||||||
| AuthorizedOfficialFirstName: | AHMED | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9108917777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1787 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 085J8 | 01 | NC | BCBS | OTHER | 89085J8 | 05 | NC | MEDICAID |