Provider Demographics
NPI:1821192402
Name:CAPE FEAR OPTOMETRIC CLINIC PA
Entity Type:Organization
Organization Name:CAPE FEAR OPTOMETRIC CLINIC PA
Other - Org Name:DOCTORS VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PHILBRICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-484-6178
Mailing Address - Street 1:665 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-9618
Mailing Address - Country:US
Mailing Address - Phone:336-372-2253
Mailing Address - Fax:
Practice Address - Street 1:665 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-9618
Practice Address - Country:US
Practice Address - Phone:336-372-2253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC0844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0912COtherBLUE CROSS BLUE SHIELD
NC89091CMedicaid
NC8909717Medicaid
NCT65112Medicare UPIN
NC8909717Medicaid
NC0912COtherBLUE CROSS BLUE SHIELD
NC246601Medicare ID - Type Unspecified