Provider Demographics
NPI:1710028519
Name:C & S OPTOMETRIC SERVICES PLLC
Entity Type:Organization
Organization Name:C & S OPTOMETRIC SERVICES PLLC
Other - Org Name:NEW BERN FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-633-0016
Mailing Address - Street 1:2805 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7351
Mailing Address - Country:US
Mailing Address - Phone:252-633-0016
Mailing Address - Fax:252-636-3895
Practice Address - Street 1:2805 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-7351
Practice Address - Country:US
Practice Address - Phone:252-633-0016
Practice Address - Fax:252-636-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890125BMedicaid
NC0125BOtherBCBS
NCVR 1266OtherVOCATIONAL REHABILITATION
NCV1890OtherBLIND COMMISSION
NCV1890OtherBLIND COMMISSION
NC890125BMedicaid