Provider Demographics
NPI:1477792067
Name:FINAL PHASE LLC
Entity Type:Organization
Organization Name:FINAL PHASE LLC
Other - Org Name:JAMES E HOMER, OCULARIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOMER
Authorized Official - Suffix:
Authorized Official - Credentials:OCULARIST
Authorized Official - Phone:252-393-5134
Mailing Address - Street 1:159 DEEPWATER DR
Mailing Address - Street 2:
Mailing Address - City:STELLA
Mailing Address - State:NC
Mailing Address - Zip Code:28582-9741
Mailing Address - Country:US
Mailing Address - Phone:252-393-5134
Mailing Address - Fax:252-393-6930
Practice Address - Street 1:1044 CEDAR POINT BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-8019
Practice Address - Country:US
Practice Address - Phone:252-393-5134
Practice Address - Fax:252-393-6930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC021642156FX1700X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC048E0OtherBLUE CROSS BLUE SHIELD OF NC
NC7705142Medicaid
NC=========OtherTRI-CARE
NC048E0OtherBLUE CROSS BLUE SHIELD OF NC