Provider Demographics
NPI:1497784664
Name:NORTHEAST EYE CENTER PA
Entity Type:Organization
Organization Name:NORTHEAST EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-786-2015
Mailing Address - Street 1:33 LAKE CONCORD RD NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-3015
Mailing Address - Country:US
Mailing Address - Phone:704-786-2015
Mailing Address - Fax:704-788-3993
Practice Address - Street 1:33 LAKE CONCORD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3015
Practice Address - Country:US
Practice Address - Phone:704-786-2015
Practice Address - Fax:704-788-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01231OtherBCBS
NC89-01231Medicaid
NC01231OtherBCBS
NC89-01231Medicaid