Provider Demographics
NPI:1013104249
Name:RED I OPTICAL, INC
Entity type:Organization
Organization Name:RED I OPTICAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-272-5252
Mailing Address - Street 1:1607 WESTOVER TER
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-1996
Mailing Address - Country:US
Mailing Address - Phone:336-272-5252
Mailing Address - Fax:336-272-0939
Practice Address - Street 1:1607 WESTOVER TERRACE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-272-5252
Practice Address - Fax:336-282-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0911152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909128Medicaid
NC8909128Medicaid
NC246227BMedicare PIN