Provider Demographics
NPI:1508045741
Name:JAMES S POPE DBA EYE CARE CLINIC
Entity Type:Organization
Organization Name:JAMES S POPE DBA EYE CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-476-3141
Mailing Address - Street 1:PO BOX 15133
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-0133
Mailing Address - Country:US
Mailing Address - Phone:919-477-5152
Mailing Address - Fax:919-477-5474
Practice Address - Street 1:1033 RANDOLPH ST STE 4
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5731
Practice Address - Country:US
Practice Address - Phone:336-475-0151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09720OtherBLUE CROSS BLUE SHIELD
NC7909720Medicaid
NC7909720Medicaid
NC2334301Medicare PIN
NC09720OtherBLUE CROSS BLUE SHIELD