Provider Demographics
NPI:1023341088
Name:NEW VISION EYECARE OD PA
Entity type:Organization
Organization Name:NEW VISION EYECARE OD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-272-9970
Mailing Address - Street 1:3214 CHARLES B ROOT WYND
Mailing Address - Street 2:SUITE 155
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5440
Mailing Address - Country:US
Mailing Address - Phone:919-881-0900
Mailing Address - Fax:919-881-0911
Practice Address - Street 1:3214 CHARLES B ROOT WYND
Practice Address - Street 2:SUITE 155
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5440
Practice Address - Country:US
Practice Address - Phone:919-881-0900
Practice Address - Fax:919-341-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC191279207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC022PUOtherBLUE CROSS & BLUE SHIELD