Provider Demographics
NPI:1013244326
Name:BURGAW EYE CENTER, O.D., P.A.
Entity Type:Organization
Organization Name:BURGAW EYE CENTER, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-779-8168
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-0787
Mailing Address - Country:US
Mailing Address - Phone:910-259-5661
Mailing Address - Fax:
Practice Address - Street 1:106 EAST SATCHWELL STREET
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5064
Practice Address - Country:US
Practice Address - Phone:910-259-5661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty