Provider Demographics
NPI:1710942271
Name:ALLEN EYE ASSOCIATES INC
Entity Type:Organization
Organization Name:ALLEN EYE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-384-0929
Mailing Address - Street 1:504 E ELIZABETH STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4404
Mailing Address - Country:US
Mailing Address - Phone:252-384-0929
Mailing Address - Fax:252-384-0916
Practice Address - Street 1:504 E ELIZABETH STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4404
Practice Address - Country:US
Practice Address - Phone:252-384-0929
Practice Address - Fax:252-384-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000300114207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093M6Medicaid
NC2333852Medicare ID - Type Unspecified
NC89093M6Medicaid