Provider Demographics
NPI:1710323803
Name:EYE CARE ASSOCIATES OD PA
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES OD PA
Other - Org Name:EYE CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:BOLICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-847-0187
Mailing Address - Street 1:7100 SIX FORKS RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6260
Mailing Address - Country:US
Mailing Address - Phone:919-847-0187
Mailing Address - Fax:919-863-2862
Practice Address - Street 1:2013 OLDE REGENT WAY
Practice Address - Street 2:SUITE 260
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4193
Practice Address - Country:US
Practice Address - Phone:910-782-1883
Practice Address - Fax:910-782-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2467603DMedicare PIN