Provider Demographics
NPI:1700211968
Name:ONE WAY EYE CARE
Entity Type:Organization
Organization Name:ONE WAY EYE CARE
Other - Org Name:EASTWAY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-568-6760
Mailing Address - Street 1:3211 EASTWAY DR
Mailing Address - Street 2:SUITE 13
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5670
Mailing Address - Country:US
Mailing Address - Phone:704-568-6760
Mailing Address - Fax:704-568-6792
Practice Address - Street 1:3211 EASTWAY DR
Practice Address - Street 2:SUITE 13
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5670
Practice Address - Country:US
Practice Address - Phone:704-568-6760
Practice Address - Fax:704-568-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1336156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8802016Medicaid