Provider Demographics
NPI:1255532537
Name:BANKS EYE CARE OD PLLC
Entity type:Organization
Organization Name:BANKS EYE CARE OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-444-2020
Mailing Address - Street 1:1401 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-1822
Mailing Address - Country:US
Mailing Address - Phone:252-444-2020
Mailing Address - Fax:
Practice Address - Street 1:1401 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-1822
Practice Address - Country:US
Practice Address - Phone:252-444-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1111152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09041OtherBCBS
NC8909148Medicaid
NC013H7OtherBCBS GROUP
NC0911FOtherBCBS
NC8909041Medicaid
NCT64729Medicare UPIN
NC0911FOtherBCBS
NCT64989Medicare UPIN
NC8909148Medicaid
NC0340720001Medicare NSC