Provider Demographics
NPI: | 1639572811 |
---|---|
Name: | MYEYEDR OPTOMETRY OF NORTH CAROLINA, PLLC |
Entity Type: | Organization |
Organization Name: | MYEYEDR OPTOMETRY OF NORTH CAROLINA, PLLC |
Other - Org Name: | MYEYEDR |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | SECRETARY |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SUE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HEALEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 703-847-8899 |
Mailing Address - Street 1: | 8614 WESTWOOD CENTER DR FL 9 |
Mailing Address - Street 2: | |
Mailing Address - City: | VIENNA |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22182-2442 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 703-847-8899 |
Mailing Address - Fax: | 571-223-6780 |
Practice Address - Street 1: | 1001 WIDEWATERS PKWY |
Practice Address - Street 2: | |
Practice Address - City: | KNIGHTDALE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27545-6102 |
Practice Address - Country: | US |
Practice Address - Phone: | 919-861-2020 |
Practice Address - Fax: | 919-277-0854 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-10-02 |
Last Update Date: | 2022-05-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |