Provider Demographics
NPI:1578514527
Name:CENTRAL CAROLINA ASSOCIATES IN OPTOMETRY PA
Entity Type:Organization
Organization Name:CENTRAL CAROLINA ASSOCIATES IN OPTOMETRY PA
Other - Org Name:THE EYECARE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-249-8901
Mailing Address - Street 1:504 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-4112
Mailing Address - Country:US
Mailing Address - Phone:336-249-8901
Mailing Address - Fax:336-248-2695
Practice Address - Street 1:1402 EASTCHESTER DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2308
Practice Address - Country:US
Practice Address - Phone:336-886-8400
Practice Address - Fax:336-886-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890918CMedicaid
NC890918CMedicaid
NC1254Medicare PIN