Provider Demographics
NPI:1407935158
Name:PRIMARY EYE CARE ASSOC OD PA
Entity Type:Organization
Organization Name:PRIMARY EYE CARE ASSOC OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SATTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-669-2901
Mailing Address - Street 1:997 OLD US HWY 70
Mailing Address - Street 2:SUITE D SWANNANOA VALLEY MEDICAL CENTER
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711
Mailing Address - Country:US
Mailing Address - Phone:828-669-2901
Mailing Address - Fax:828-669-4257
Practice Address - Street 1:997 OLD US HWY 70
Practice Address - Street 2:SUITE D SWANNANOA VALLEY MEDICAL CENTER
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711
Practice Address - Country:US
Practice Address - Phone:828-669-2901
Practice Address - Fax:828-669-4257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1156152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909805Medicaid
T64980Medicare UPIN
NC7909805Medicaid