Provider Demographics
NPI:1174646533
Name:EYE PROS, INC
Entity Type:Organization
Organization Name:EYE PROS, INC
Other - Org Name:EYE PROS VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:704-362-0098
Mailing Address - Street 1:4400 SHARON RD
Mailing Address - Street 2:LEVEL 4 BELK
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3531
Mailing Address - Country:US
Mailing Address - Phone:704-362-0098
Mailing Address - Fax:704-362-0098
Practice Address - Street 1:4400 SHARON RD
Practice Address - Street 2:LEVEL 4 BELK
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3531
Practice Address - Country:US
Practice Address - Phone:704-362-0098
Practice Address - Fax:704-362-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC289332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8802068Medicaid
NC0357270001Medicare ID - Type UnspecifiedOPTICAL