Basic Information
| Provider Information | |||||||||
| NPI: | 1710323803 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE CARE ASSOCIATES OD PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EYE CARE ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7100 SIX FORKS RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276156260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198470187 | ||||||||
| FaxNumber: | 9198632862 | ||||||||
| Practice Location | |||||||||
| Address1: | 2013 OLDE REGENT WAY | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | LELAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284514193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107821883 | ||||||||
| FaxNumber: | 9107821884 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2013 | ||||||||
| LastUpdateDate: | 08/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | BOLICK | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | FORD | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9198470187 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.