Provider Demographics
NPI:1376903559
Name:PARKSIDE EYE CARE, OD, PLLC
Entity Type:Organization
Organization Name:PARKSIDE EYE CARE, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIADN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:919-883-9987
Mailing Address - Street 1:7250 O'KELLY CHAPEL ROAD
Mailing Address - Street 2:STE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519
Mailing Address - Country:US
Mailing Address - Phone:919-883-9987
Mailing Address - Fax:919-887-6381
Practice Address - Street 1:7250 O'KELLY CHAPEL ROAD
Practice Address - Street 2:STE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519
Practice Address - Country:US
Practice Address - Phone:919-883-9987
Practice Address - Fax:919-887-6381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty