Provider Demographics
NPI:1356629026
Name:ABLOTT, ERIC JAMES (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:ABLOTT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W ACADEMY STREET
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317
Mailing Address - Country:US
Mailing Address - Phone:336-495-3937
Mailing Address - Fax:336-495-3938
Practice Address - Street 1:200 WEST ACADEMY ST
Practice Address - Street 2:
Practice Address - City:RANDLEMAN
Practice Address - State:NC
Practice Address - Zip Code:27317
Practice Address - Country:US
Practice Address - Phone:336-495-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1370152W00000X
NC2309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCE257AMedicare PIN