Provider Demographics
NPI:1164833851
Name:MOORESVILLE EYE CARE, OD, PLLC
Entity Type:Organization
Organization Name:MOORESVILLE EYE CARE, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEBELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-663-3924
Mailing Address - Street 1:404 E CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2544
Mailing Address - Country:US
Mailing Address - Phone:704-663-3924
Mailing Address - Fax:704-663-7057
Practice Address - Street 1:404 E CENTER AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2544
Practice Address - Country:US
Practice Address - Phone:704-663-3924
Practice Address - Fax:704-663-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1884152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093PGMedicaid
NC8909775Medicaid
NCU96137Medicare UPIN
NC8909775Medicaid