Provider Demographics
NPI:1376609818
Name:WILMINGTON EYE CARE ASSOCIATES OD
Entity Type:Organization
Organization Name:WILMINGTON EYE CARE ASSOCIATES OD
Other - Org Name:EYE CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-847-0187
Mailing Address - Street 1:7100 SIX FORKS RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6156
Mailing Address - Country:US
Mailing Address - Phone:919-847-0187
Mailing Address - Fax:919-676-2231
Practice Address - Street 1:6825 PARKER FARM DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3168
Practice Address - Country:US
Practice Address - Phone:910-452-0554
Practice Address - Fax:910-452-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905844Medicaid
NC018TGOtherBLUECROSS
NCDP7929OtherMEDICARE RAILROAD CARRIER
NC5817450001Medicare NSC
NCDP7929OtherMEDICARE RAILROAD CARRIER