Basic Information
| Provider Information | |||||||||
| NPI: | 1770764946 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIRST CHOICE EYE CARE, OD, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14617 LAWYERS RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MATTHEWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281043219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048930090 | ||||||||
| FaxNumber: | 7048930944 | ||||||||
| Practice Location | |||||||||
| Address1: | 14617 LAWYERS RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MATTHEWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281043219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048930090 | ||||||||
| FaxNumber: | 7048930944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2007 | ||||||||
| LastUpdateDate: | 12/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | BIGHAM | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 7048930090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | NC1746 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 22.00365 | 01 | UNITED HEALTHCARE | OTHER | 68011 | 01 | BEACHSTREET | OTHER | 803877 | 01 | COMMUNITY EYE | OTHER | B9267 | 01 | MEDCOST PREFERRED | OTHER | 0925E | 01 | NC | BCBS | OTHER | 24119 | 01 | AVESIS | OTHER | 803877 | 01 | PARTNERS MEDICARE | OTHER | 90703 | 01 | MAMSI | OTHER | 890925E | 05 | NC | MEDICAID | B9267 | 01 | MEDCOST | OTHER | ND1746 | 01 | VISION BENEFITS OF AMERIC | OTHER | DD2824 | 01 | RAILROAD MEDICARE | OTHER |