Provider Demographics
NPI:1790736106
Name:CHAPEL HILL EYE CARE AND OPTOMETRY PA
Entity Type:Organization
Organization Name:CHAPEL HILL EYE CARE AND OPTOMETRY PA
Other - Org Name:CHAPEL HILL EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY FOR CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:STICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-968-4774
Mailing Address - Street 1:235 S ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5831
Mailing Address - Country:US
Mailing Address - Phone:919-968-4774
Mailing Address - Fax:919-942-5291
Practice Address - Street 1:235 S ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5831
Practice Address - Country:US
Practice Address - Phone:919-968-4774
Practice Address - Fax:919-942-5291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0152QOtherBCBS OF NC
NC2460114Medicare PIN
NC0609920001Medicare NSC
T30464Medicare UPIN