Provider Demographics
NPI:1861465205
Name:CAROLINA EYE PROSTHETICS, INC.
Entity Type:Organization
Organization Name:CAROLINA EYE PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:336-228-7877
Mailing Address - Street 1:420 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5934
Mailing Address - Country:US
Mailing Address - Phone:336-228-7877
Mailing Address - Fax:336-228-7514
Practice Address - Street 1:420 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5934
Practice Address - Country:US
Practice Address - Phone:336-228-7877
Practice Address - Fax:336-228-7514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
NC335E00000X335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0494IOtherBLUE CROSS BLUE SHIELD
NC7704513Medicaid
NC0494IOtherBLUE CROSS BLUE SHIELD