Provider Demographics
NPI:1376582239
Name:EYECARECENTER OD PA
Entity Type:Organization
Organization Name:EYECARECENTER OD PA
Other - Org Name:OPTOMETRIC EYE CARE CENTER OD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-200-4393
Mailing Address - Street 1:PO BOX 207261
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7261
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0799
Practice Address - Street 1:3401B RALEIGH ROAD PKWY W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8217
Practice Address - Country:US
Practice Address - Phone:252-291-0767
Practice Address - Fax:252-291-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909165Medicaid
NCCA8262OtherRR MEDICARE GROUP
NY09165OtherBCBSNC GROUP NUMBER
NY09165OtherBCBSNC GROUP NUMBER
NC0222680005Medicare NSC