Provider Demographics
NPI:1639137888
Name:CAROLINA FAMILY OPTOMETRY, PLLC
Entity Type:Organization
Organization Name:CAROLINA FAMILY OPTOMETRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:DRENNEN
Authorized Official - Last Name:CRIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-872-0616
Mailing Address - Street 1:1116 CROSSROADS DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8277
Mailing Address - Country:US
Mailing Address - Phone:704-872-0616
Mailing Address - Fax:704-872-6494
Practice Address - Street 1:1116 CROSSROADS DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-8277
Practice Address - Country:US
Practice Address - Phone:704-872-0616
Practice Address - Fax:704-872-6494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1887152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015EXOtherGROUP NUMBER (BCBS)