Provider Demographics
NPI:1184766644
Name:C & S OPTOMETRIC SERVICES PLLC
Entity type:Organization
Organization Name:C & S OPTOMETRIC SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-745-4100
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NC
Mailing Address - Zip Code:28509-0219
Mailing Address - Country:US
Mailing Address - Phone:252-745-4100
Mailing Address - Fax:252-745-3909
Practice Address - Street 1:13820 HWY 55 E
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NC
Practice Address - Zip Code:28509-0219
Practice Address - Country:US
Practice Address - Phone:252-745-4100
Practice Address - Fax:252-745-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0203COtherBCBS
NC890203CMedicaid
NCY1890OtherBLIND COMMISSION
NC890203CMedicaid
NC0203COtherBCBS