Provider Demographics
NPI:1518094374
Name:VISION ONE EYE CENTER OD PA
Entity Type:Organization
Organization Name:VISION ONE EYE CENTER OD PA
Other - Org Name:O'CONNELL & MARTIN EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:IV
Authorized Official - Credentials:OD
Authorized Official - Phone:919-776-1012
Mailing Address - Street 1:405 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-6119
Mailing Address - Country:US
Mailing Address - Phone:919-776-1012
Mailing Address - Fax:919-775-3420
Practice Address - Street 1:405 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-6119
Practice Address - Country:US
Practice Address - Phone:919-776-1012
Practice Address - Fax:919-775-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1737152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1952393035OtherPROVIDER NPI
NC1952393035OtherPROVIDER NPI
NCU75080Medicare UPIN
5478950001Medicare NSC