Provider Demographics
NPI:1669475117
Name:CAROLINA EYE SURGICAL AND LASER CENTER
Entity Type:Organization
Organization Name:CAROLINA EYE SURGICAL AND LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BERGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-854-4441
Mailing Address - Street 1:1002 N CHURCH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1439
Mailing Address - Country:US
Mailing Address - Phone:336-854-4441
Mailing Address - Fax:336-854-7883
Practice Address - Street 1:1002 N CHURCH ST
Practice Address - Street 2:STE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1448
Practice Address - Country:US
Practice Address - Phone:336-854-4441
Practice Address - Fax:336-854-7883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-28
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23173207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty