Provider Demographics
NPI:1720125347
Name:SJS OPTICS OF HIGH POINT NC
Entity Type:Organization
Organization Name:SJS OPTICS OF HIGH POINT NC
Other - Org Name:OPTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWAIM
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:336-884-5677
Mailing Address - Street 1:1105 N LINDSAY ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3935
Mailing Address - Country:US
Mailing Address - Phone:336-884-5677
Mailing Address - Fax:336-884-4307
Practice Address - Street 1:1105 N LINDSAY ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3935
Practice Address - Country:US
Practice Address - Phone:336-884-5677
Practice Address - Fax:336-884-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1516332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8801858Medicaid
NC8801858Medicaid