Provider Demographics
NPI:1750682241
Name:AMERICAN EYE CARE OPTOMETRIC CENTERS PA
Entity Type:Organization
Organization Name:AMERICAN EYE CARE OPTOMETRIC CENTERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-323-2100
Mailing Address - Street 1:1657 OWEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3425
Mailing Address - Country:US
Mailing Address - Phone:910-323-2100
Mailing Address - Fax:910-323-2165
Practice Address - Street 1:1657 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3425
Practice Address - Country:US
Practice Address - Phone:910-323-2100
Practice Address - Fax:910-323-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909089Medicaid
NC8909089Medicaid
NC2466585AMedicare PIN