Provider Demographics
NPI:1730286980
Name:PAPAZEKOS, JODY DALE (OD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:DALE
Last Name:PAPAZEKOS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-0231
Mailing Address - Country:US
Mailing Address - Phone:828-632-4566
Mailing Address - Fax:828-352-9511
Practice Address - Street 1:19 S CENTER ST
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-2500
Practice Address - Country:US
Practice Address - Phone:828-632-4566
Practice Address - Fax:828-352-9511
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC001971501OtherUNITED HEALTHCARE ID
NC890917MMedicaid
NC0917MOtherBCBS PROVIDER NUMBER
NC119986000OtherDMERC PROVIDER NUMBER
NCY-1947OtherDIV SERV FOR THE BLIND ID
NC890917MMedicaid
NC0917MOtherBCBS PROVIDER NUMBER