Provider Demographics
NPI:1669439139
Name:COLUMBUS EYE ASSOCIATES OD PA
Entity type:Organization
Organization Name:COLUMBUS EYE ASSOCIATES OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-642-2020
Mailing Address - Street 1:PO BOX 1437
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-1437
Mailing Address - Country:US
Mailing Address - Phone:910-642-2020
Mailing Address - Fax:910-642-4549
Practice Address - Street 1:221 JEFFERSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3415
Practice Address - Country:US
Practice Address - Phone:910-642-2020
Practice Address - Fax:910-642-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09084OtherBCBS
NC8909084Medicaid
NC1273Medicare ID - Type Unspecified
NC09084OtherBCBS