Provider Demographics
NPI:1134349012
Name:LOOKING GLASS EYE CENTER P A
Entity type:Organization
Organization Name:LOOKING GLASS EYE CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-693-4161
Mailing Address - Street 1:188 MEDICAL PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712
Mailing Address - Country:US
Mailing Address - Phone:828-884-7320
Mailing Address - Fax:
Practice Address - Street 1:188 MEDICAL PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712
Practice Address - Country:US
Practice Address - Phone:828-884-7320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890195GMedicaid
NC2330754Medicare ID - Type Unspecified
NC4652150001Medicare NSC