Provider Demographics
NPI:1235511536
Name:SEASHORE EYE ASSOCIATES, OD, PLLC
Entity Type:Organization
Organization Name:SEASHORE EYE ASSOCIATES, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:910-769-2740
Mailing Address - Street 1:1616 DOCTORS CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7406
Mailing Address - Country:US
Mailing Address - Phone:910-769-2740
Mailing Address - Fax:910-769-3622
Practice Address - Street 1:1616 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7406
Practice Address - Country:US
Practice Address - Phone:910-769-2740
Practice Address - Fax:910-769-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty