Provider Demographics
NPI:1457432577
Name:FAMILY EYE CENTER OD PA
Entity Type:Organization
Organization Name:FAMILY EYE CENTER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-438-6132
Mailing Address - Street 1:560 DABNEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536
Mailing Address - Country:US
Mailing Address - Phone:252-438-6132
Mailing Address - Fax:252-438-5161
Practice Address - Street 1:560 DABNEY DRIVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536
Practice Address - Country:US
Practice Address - Phone:252-438-6132
Practice Address - Fax:252-438-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890920FMedicaid
NC890980AMedicaid
NC890204NMedicaid
NC8909432Medicaid
NC890971AMedicaid
NC8909180Medicaid
NC8909439Medicaid
NC8909407Medicaid
NC890914AMedicaid
NC890914AMedicaid
NC0212770003Medicare NSC
NC890971AMedicaid
NC8909432Medicaid
NC0212770004Medicare NSC
NC2467694Medicare PIN