Provider Demographics
NPI:1639247968
Name:HOMER, JAMES ELLSWORTH (OCULARIST)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ELLSWORTH
Last Name:HOMER
Suffix:
Gender:M
Credentials:OCULARIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:159 DEEPWATER DR
Mailing Address - Street 2:
Mailing Address - City:STELLA
Mailing Address - State:NC
Mailing Address - Zip Code:28582-9741
Mailing Address - Country:US
Mailing Address - Phone:800-579-6363
Mailing Address - Fax:252-393-6930
Practice Address - Street 1:1044 CEDAR POINT BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-8019
Practice Address - Country:US
Practice Address - Phone:800-579-6363
Practice Address - Fax:252-393-6930
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC048E0OtherBLUE CROSS BLUE SHIELD OF NC
NC260464169OtherTRI-CARE
NC7705142Medicaid
NC7705142Medicaid