Provider Demographics
NPI:1831103753
Name:EYE ASSOCIATES OF ROWAN PA
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF ROWAN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGSMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-633-0345
Mailing Address - Street 1:800 W CEMETARY ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3212
Mailing Address - Country:US
Mailing Address - Phone:704-633-0345
Mailing Address - Fax:704-636-4981
Practice Address - Street 1:800 W CEMETARY ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3212
Practice Address - Country:US
Practice Address - Phone:704-633-0345
Practice Address - Fax:704-636-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800469207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2280715OtherRAILROAD MEDICARE
2344568Medicare ID - Type Unspecified