Provider Demographics
NPI:1720259997
Name:THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Entity Type:Organization
Organization Name:THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Other - Org Name:UNC OPTICAL SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP - FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-966-6862
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 420
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5491
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2226 NELSON HWY STE 200
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-9638
Practice Address - Country:US
Practice Address - Phone:984-974-2039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-17
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8802054Medicaid