Provider Demographics
NPI:1043416597
Name:CAROLINA OPTICAL PARTNERS
Entity Type:Organization
Organization Name:CAROLINA OPTICAL PARTNERS
Other - Org Name:CAROLINA OPTICAL SHOP SANFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOODCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-485-3937
Mailing Address - Street 1:1829 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5067
Mailing Address - Country:US
Mailing Address - Phone:919-776-2032
Mailing Address - Fax:
Practice Address - Street 1:2047 VALLEYGATE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3688
Practice Address - Country:US
Practice Address - Phone:910-485-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNOT REQUIRED IN SANF332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8802093Medicaid
NC8802093Medicaid