Provider Demographics
NPI:1356675532
Name:BLINK EYE CARE AND EYE WEAR OD., PA
Entity Type:Organization
Organization Name:BLINK EYE CARE AND EYE WEAR OD., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:MACINTYRE
Authorized Official - Last Name:RAYKOVICZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-817-3800
Mailing Address - Street 1:16618 RIVERSTONE WAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-5746
Mailing Address - Country:US
Mailing Address - Phone:704-817-3800
Mailing Address - Fax:
Practice Address - Street 1:16618 RIVERSTONE WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3823
Practice Address - Country:US
Practice Address - Phone:704-817-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1894152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty