Provider Demographics
NPI:1265490395
Name:VISIQUE OPTOMETRY, PLLC
Entity Type:Organization
Organization Name:VISIQUE OPTOMETRY, PLLC
Other - Org Name:EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-362-0332
Mailing Address - Street 1:800 W WILLIAMS ST
Mailing Address - Street 2:SUITE 164
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-5203
Mailing Address - Country:US
Mailing Address - Phone:919-362-0332
Mailing Address - Fax:919-362-0933
Practice Address - Street 1:800 W WILLIAMS ST
Practice Address - Street 2:SUITE 164
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-5203
Practice Address - Country:US
Practice Address - Phone:919-362-0332
Practice Address - Fax:919-362-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902115Medicaid
NC2348711Medicare ID - Type Unspecified
NC6418540001Medicare NSC