Provider Demographics
NPI:1437272911
Name:CAROLINA EYE CARE PROFESSIONALS, PA
Entity Type:Organization
Organization Name:CAROLINA EYE CARE PROFESSIONALS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANETTE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:BAROWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-592-5379
Mailing Address - Street 1:340A NORTHEAST BLVD
Mailing Address - Street 2:JORDAN SHOPPING CENTER
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2424
Mailing Address - Country:US
Mailing Address - Phone:910-592-5379
Mailing Address - Fax:910-592-5353
Practice Address - Street 1:340A NORTHEAST BLVD
Practice Address - Street 2:JORDAN SHOPPING CENTER
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2424
Practice Address - Country:US
Practice Address - Phone:910-592-5379
Practice Address - Fax:910-592-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC126748332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2345961Medicare PIN
NC5684510001Medicare NSC