Provider Demographics
NPI:1235718248
Name:OAK CITY VISION CENTER OD PLLC
Entity Type:Organization
Organization Name:OAK CITY VISION CENTER OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:G
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-341-4688
Mailing Address - Street 1:8821 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2970
Mailing Address - Country:US
Mailing Address - Phone:919-341-4688
Mailing Address - Fax:919-647-7755
Practice Address - Street 1:8821 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2970
Practice Address - Country:US
Practice Address - Phone:919-341-4688
Practice Address - Fax:919-647-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1619455268Medicaid