Provider Demographics
NPI:1235259516
Name:LIONS SERVICES, INC.
Entity Type:Organization
Organization Name:LIONS SERVICES, INC.
Other - Org Name:LIONS SERVICES EYE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-921-1527
Mailing Address - Street 1:4600 N TRYON ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-7058
Mailing Address - Country:US
Mailing Address - Phone:704-599-4760
Mailing Address - Fax:704-921-5758
Practice Address - Street 1:4600 N TRYON ST STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-7058
Practice Address - Country:US
Practice Address - Phone:704-599-4760
Practice Address - Fax:704-921-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCX-0736332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01733OtherNC HEALTH CHOICE
NC8801960Medicaid
NC890206LMedicaid
NC01733OtherNC HEALTH CHOICE