Provider Demographics
NPI:1366471526
Name:ADVANCED FAMILY EYE CARE - DRS OF OPTOMETRY PLLC
Entity Type:Organization
Organization Name:ADVANCED FAMILY EYE CARE - DRS OF OPTOMETRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DD
Authorized Official - Phone:704-822-9920
Mailing Address - Street 1:7547 WATERSIDE LOOP RD
Mailing Address - Street 2:STE A
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-7677
Mailing Address - Country:US
Mailing Address - Phone:704-822-9920
Mailing Address - Fax:704-822-1764
Practice Address - Street 1:7547 WATERSIDE LOOP RD
Practice Address - Street 2:STE A
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7677
Practice Address - Country:US
Practice Address - Phone:704-822-9920
Practice Address - Fax:704-822-1764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1850152W00000X
NC1857152W00000X
NC2046152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015G1Medicaid
NC015G1OtherBCBS
NC2335465Medicare ID - Type Unspecified
NC89015G1Medicaid