Provider Demographics
NPI:1265740203
Name:EYE CONSULTANTS OF GREENSBORO, P.A.
Entity type:Organization
Organization Name:EYE CONSULTANTS OF GREENSBORO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:336-389-0242
Mailing Address - Street 1:3810 N ELM ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2727
Mailing Address - Country:US
Mailing Address - Phone:336-389-0242
Mailing Address - Fax:336-389-0263
Practice Address - Street 1:3810 N ELM ST
Practice Address - Street 2:SUITE 209
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2727
Practice Address - Country:US
Practice Address - Phone:336-389-0242
Practice Address - Fax:336-389-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26482207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5748630001Medicare NSC