Provider Demographics
NPI:1235173527
Name:SILER CROSSING VISION CENTER OPTOMETRY PA
Entity Type:Organization
Organization Name:SILER CROSSING VISION CENTER OPTOMETRY PA
Other - Org Name:SILER CROSSING VISION CENTER OPTOMETRY PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HAGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:919-742-5007
Mailing Address - Street 1:1603 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-2823
Mailing Address - Country:US
Mailing Address - Phone:919-742-5007
Mailing Address - Fax:919-742-4599
Practice Address - Street 1:1603 E 11TH ST
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-2823
Practice Address - Country:US
Practice Address - Phone:919-742-5007
Practice Address - Fax:919-742-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011KRMedicaid
NC89011KRMedicaid
NC4579970001Medicare NSC
NC2472306Medicare ID - Type Unspecified