Provider Demographics
NPI:1336370832
Name:CARTERET EYE CENTER OD PA
Entity Type:Organization
Organization Name:CARTERET EYE CENTER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:HYMAN
Authorized Official - Last Name:MEWBORN
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:252-247-4661
Mailing Address - Street 1:5053 EXECUTIVE DR STE A
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2506
Mailing Address - Country:US
Mailing Address - Phone:252-247-4661
Mailing Address - Fax:252-247-3776
Practice Address - Street 1:5053 EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2506
Practice Address - Country:US
Practice Address - Phone:252-247-4661
Practice Address - Fax:252-247-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0822152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1144203522OtherNPI - INDIVIDUAL
246018BMedicare PIN
NC1144203522OtherNPI - INDIVIDUAL
T64595Medicare UPIN