Provider Demographics
NPI:1114783883
Name:DR A FAMILY EYECARE
Entity Type:Organization
Organization Name:DR A FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAKKAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-701-7622
Mailing Address - Street 1:4275 GOLDSBORO RD
Mailing Address - Street 2:
Mailing Address - City:WADE
Mailing Address - State:NC
Mailing Address - Zip Code:28395-8777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4431 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1443
Practice Address - Country:US
Practice Address - Phone:919-261-1180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588181507Medicaid