Provider Demographics
NPI:1710926662
Name:WILSON EYE ASSOCIATES OPTOMETRISTS, PA
Entity Type:Organization
Organization Name:WILSON EYE ASSOCIATES OPTOMETRISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:BLACKMON
Authorized Official - Last Name:BOYKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-243-2020
Mailing Address - Street 1:2402 MONTGOMERY DR SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4421
Mailing Address - Country:US
Mailing Address - Phone:252-243-2020
Mailing Address - Fax:252-291-2020
Practice Address - Street 1:2402 MONTGOMERY DR SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4421
Practice Address - Country:US
Practice Address - Phone:252-243-2020
Practice Address - Fax:252-291-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0190YOtherBCBS
NC890190YMedicaid
NC2467878Medicare PIN
NC0312480001Medicare NSC