Provider Demographics
NPI:1962450098
Name:POOLE EYECARE PA
Entity Type:Organization
Organization Name:POOLE EYECARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-739-5581
Mailing Address - Street 1:808 W KING ST
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-2748
Mailing Address - Country:US
Mailing Address - Phone:704-739-5581
Mailing Address - Fax:704-739-0000
Practice Address - Street 1:808 W KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MTN
Practice Address - State:NC
Practice Address - Zip Code:28086-2748
Practice Address - Country:US
Practice Address - Phone:704-739-5581
Practice Address - Fax:704-739-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1109152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-09655Medicaid
NC246431AMedicare PIN
NCT24412Medicare UPIN
NC0652710002Medicare NSC
NCT24412Medicare UPIN