Provider Demographics
NPI:1114050192
Name:PROFESSIONAL EYECARE OPTOMETRY PA
Entity Type:Organization
Organization Name:PROFESSIONAL EYECARE OPTOMETRY PA
Other - Org Name:SEARS EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-423-0700
Mailing Address - Street 1:400 CROSS CREEK MALL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-7244
Mailing Address - Country:US
Mailing Address - Phone:910-864-1009
Mailing Address - Fax:
Practice Address - Street 1:400 CROSS CREEK MALL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7244
Practice Address - Country:US
Practice Address - Phone:910-864-1009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1508152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty