Provider Demographics
NPI:1780864645
Name:CAROLINA'S PROFESSIONAL EYECARE ASSOCIATES, OD, PA
Entity Type:Organization
Organization Name:CAROLINA'S PROFESSIONAL EYECARE ASSOCIATES, OD, PA
Other - Org Name:DR. SYLVIA HERNANDEZ
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:704-788-1975
Mailing Address - Street 1:280 CONCORD PKWY S
Mailing Address - Street 2:SUITE 110-C
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6730
Mailing Address - Country:US
Mailing Address - Phone:704-788-1975
Mailing Address - Fax:704-788-1976
Practice Address - Street 1:280 CONCORD PKWY S
Practice Address - Street 2:SUITE 110-C
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6730
Practice Address - Country:US
Practice Address - Phone:704-788-1975
Practice Address - Fax:704-788-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1842152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901648Medicaid
NC5901648Medicaid