Provider Demographics
NPI:1336299684
Name:BLADEN EYE CENTER, O.D., P.A.
Entity Type:Organization
Organization Name:BLADEN EYE CENTER, O.D., P.A.
Other - Org Name:BLADEN EYE CENTER, O.D., P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-862-4268
Mailing Address - Street 1:PO BOX 2589
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-2589
Mailing Address - Country:US
Mailing Address - Phone:910-862-4268
Mailing Address - Fax:910-862-2057
Practice Address - Street 1:409 EAST BROAD STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-2589
Practice Address - Country:US
Practice Address - Phone:910-862-4268
Practice Address - Fax:910-862-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1447152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890152JMedicaid
NC0152JOtherBCBS NC
NC0152JOtherBCBS NC
NC2470078Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NC890152JMedicaid