Provider Demographics
NPI:1235140484
Name:FOUR COUNTY EYE ASSOCIATES
Entity Type:Organization
Organization Name:FOUR COUNTY EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:252-492-8021
Mailing Address - Street 1:451 RUIN CREEK RD
Mailing Address - Street 2:STE 204
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536
Mailing Address - Country:US
Mailing Address - Phone:252-492-8021
Mailing Address - Fax:252-492-3420
Practice Address - Street 1:451 RUIN CREEK RD
Practice Address - Street 2:STE 204
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536
Practice Address - Country:US
Practice Address - Phone:252-492-8021
Practice Address - Fax:252-492-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20468207W00000X
NC38075207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7901864Medicaid
NC01864OtherBCBS
NC1235140484Medicare PIN
NC0138780001Medicare NSC