Provider Demographics
NPI:1003182841
Name:AL H. COVINGTON, OD PA
Entity Type:Organization
Organization Name:AL H. COVINGTON, OD PA
Other - Org Name:COVINGTON OPTOMETRIC EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AL
Authorized Official - Middle Name:H
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-694-6799
Mailing Address - Street 1:310 N. GREENE ST.
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170
Mailing Address - Country:US
Mailing Address - Phone:704-694-6799
Mailing Address - Fax:704-694-9827
Practice Address - Street 1:310 N. GREENE ST.
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170
Practice Address - Country:US
Practice Address - Phone:704-694-6799
Practice Address - Fax:704-694-9827
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AL H COVINGTON, OD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890915CMedicaid
NCCA7791OtherRR MEDICARE
NCCA7791OtherRR MEDICARE
NC0216000002Medicare NSC