Provider Demographics
NPI:1679032288
Name:HAMPSTEAD OPTOMETRY PA
Entity Type:Organization
Organization Name:HAMPSTEAD OPTOMETRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:FARABAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-495-0031
Mailing Address - Street 1:101 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-2550
Mailing Address - Country:US
Mailing Address - Phone:856-495-0031
Mailing Address - Fax:
Practice Address - Street 1:16747 US HIGHWAY 17 N STE 140
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3695
Practice Address - Country:US
Practice Address - Phone:856-495-0031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1770685372Medicaid