Basic Information
| Provider Information | |||||||||
| NPI: | 1699483586 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYECARE SPECIALTIES OF NORTH CAROLINA OD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 E 4TH ST STE 440 | ||||||||
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| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620026241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184629818 | ||||||||
| FaxNumber: | 3147414947 | ||||||||
| Practice Location | |||||||||
| Address1: | 504 VILLAGE WALK DR | ||||||||
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| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275404440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193518600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2022 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | ALLISON | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. DIR. RCM/MVC | ||||||||
| AuthorizedOfficialTelephone: | 6184629818 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.