Provider Demographics
NPI:1760545792
Name:PIEDMONT EYE CENTER, P.A.
Entity Type:Organization
Organization Name:PIEDMONT EYE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-282-3940
Mailing Address - Street 1:3810 N ELM ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2727
Mailing Address - Country:US
Mailing Address - Phone:336-282-3940
Mailing Address - Fax:336-282-8404
Practice Address - Street 1:3810 N ELM ST
Practice Address - Street 2:SUITE 209
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2727
Practice Address - Country:US
Practice Address - Phone:336-282-3940
Practice Address - Fax:336-282-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890257XMedicaid
NC213858BMedicare ID - Type Unspecified
NC890257XMedicaid