Provider Demographics
NPI:1578527040
Name:MECKLENBURG EYE ASSOCIATES PA
Entity Type:Organization
Organization Name:MECKLENBURG EYE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-334-2020
Mailing Address - Street 1:2015 RANDOLPH RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1200
Mailing Address - Country:US
Mailing Address - Phone:704-334-2020
Mailing Address - Fax:704-334-6175
Practice Address - Street 1:2015 RANDOLPH RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1200
Practice Address - Country:US
Practice Address - Phone:704-334-2020
Practice Address - Fax:704-334-6175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890206CMedicaid
NC230467Medicare ID - Type UnspecifiedNC MEDICARE GROUP NO