Provider Demographics
NPI:1649445313
Name:CABARRUS EYE CENTER, PA
Entity type:Organization
Organization Name:CABARRUS EYE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PARTNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:K
Authorized Official - Last Name:LARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-782-1127
Mailing Address - Street 1:201 LEPHILLIP COURT, NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2900
Mailing Address - Country:US
Mailing Address - Phone:704-782-1127
Mailing Address - Fax:704-782-1207
Practice Address - Street 1:201 LEPHILLIP CT, NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-782-1127
Practice Address - Fax:704-782-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0164430001Medicare PIN