Provider Demographics
NPI:1609909555
Name:ACADEMY EYE CENTER OPTOMETRY, PA
Entity Type:Organization
Organization Name:ACADEMY EYE CENTER OPTOMETRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-460-0499
Mailing Address - Street 1:1120 RANDOLPH ST
Mailing Address - Street 2:SUITE 32
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-5174
Mailing Address - Country:US
Mailing Address - Phone:336-475-0143
Mailing Address - Fax:336-472-6831
Practice Address - Street 1:209 W NAOMI ST
Practice Address - Street 2:
Practice Address - City:RANDLEMAN
Practice Address - State:NC
Practice Address - Zip Code:27317-1733
Practice Address - Country:US
Practice Address - Phone:336-495-5700
Practice Address - Fax:336-495-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0853510001OtherCIGNA GOVERNMENT SERVIES MEDICARE PART B DME
NC011KTOtherBCBS GROUP-R
NC89011KPMedicaid
NC89011KPMedicaid
NC011KTOtherBCBS GROUP-R
NC0853510001OtherCIGNA GOVERNMENT SERVIES MEDICARE PART B DME
NC2471773Medicare PIN