Provider Demographics
NPI:1861472037
Name:PIEDMONT EYE CARE O.D.,P.A.
Entity Type:Organization
Organization Name:PIEDMONT EYE CARE O.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-867-1210
Mailing Address - Street 1:1302 E GARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5129
Mailing Address - Country:US
Mailing Address - Phone:704-867-1210
Mailing Address - Fax:
Practice Address - Street 1:1302 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5129
Practice Address - Country:US
Practice Address - Phone:704-867-1210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-21
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1142152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908187Medicaid
NC1179OtherMEDICARE GROUP/ORGANIZATION PTAN
NC1179OtherMEDICARE GROUP/ORGANIZATION PTAN
NC5908187Medicaid