Provider Demographics
NPI:1336363704
Name:CARY VISION CARE, O.D., P.A.
Entity Type:Organization
Organization Name:CARY VISION CARE, O.D., P.A.
Other - Org Name:CARY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:STIKELEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-467-9834
Mailing Address - Street 1:1100 NW MAYNARD RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8706
Mailing Address - Country:US
Mailing Address - Phone:919-467-9834
Mailing Address - Fax:919-466-0045
Practice Address - Street 1:1100 NW MAYNARD RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8706
Practice Address - Country:US
Practice Address - Phone:919-467-9834
Practice Address - Fax:919-466-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2472076Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
4530540001Medicare NSC