Provider Demographics
NPI:1639276835
Name:SUMMIT EYE CARE, PA
Entity Type:Organization
Organization Name:SUMMIT EYE CARE, PA
Other - Org Name:ACCENT OPTICAL COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHEMSARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-756-0960
Mailing Address - Street 1:1714 S. HAWTHORNE ROAD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4016
Mailing Address - Country:US
Mailing Address - Phone:336-768-8854
Mailing Address - Fax:336-765-7453
Practice Address - Street 1:1714 S. HAWTHORNE ROAD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4016
Practice Address - Country:US
Practice Address - Phone:336-768-8854
Practice Address - Fax:336-765-7453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT EYE CARE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC601156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0161590001Medicare NSC