Provider Demographics
NPI:1578749180
Name:W. ALEX APPANAITIS, O.D., P.A.
Entity Type:Organization
Organization Name:W. ALEX APPANAITIS, O.D., P.A.
Other - Org Name:FORSYTH FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:APPANAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-924-9121
Mailing Address - Street 1:312 SONATA DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-8301
Mailing Address - Country:US
Mailing Address - Phone:336-924-9121
Mailing Address - Fax:336-924-6215
Practice Address - Street 1:5305 ROBINHOOD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-9820
Practice Address - Country:US
Practice Address - Phone:336-924-9121
Practice Address - Fax:336-924-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1655152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890914WMedicaid
NC5950461Medicaid
NC2470793BMedicare PIN