Provider Demographics
NPI:1023474053
Name:EAST COAST OPTOMETRIC ASSOCIATES, PA
Entity type:Organization
Organization Name:EAST COAST OPTOMETRIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:DVORZSAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-793-1517
Mailing Address - Street 1:5226 SIGMON RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1666
Mailing Address - Country:US
Mailing Address - Phone:910-793-1517
Mailing Address - Fax:910-793-1518
Practice Address - Street 1:5226 SIGMON RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1666
Practice Address - Country:US
Practice Address - Phone:910-793-1517
Practice Address - Fax:910-793-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1901152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty