Provider Demographics
NPI:1184759102
Name:FANELLI EYE ASSOCIATES,OD, PA.
Entity type:Organization
Organization Name:FANELLI EYE ASSOCIATES,OD, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:FANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-452-7225
Mailing Address - Street 1:5526B CAROLINA BEACH RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2606
Mailing Address - Country:US
Mailing Address - Phone:910-452-7225
Mailing Address - Fax:910-452-7229
Practice Address - Street 1:5526B CAROLINA BEACH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2606
Practice Address - Country:US
Practice Address - Phone:910-452-7225
Practice Address - Fax:910-452-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1188152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012YTMedicaid
NC09077OtherBCBS
NC=========OtherSUPERIOR VISION
NC09077OtherBCBS
NC=========OtherVISION SERVICE PLAN
NC89012YTMedicaid
NC=========OtherSUPERIOR VISION
NC=========OtherCIGNA