Provider Demographics
NPI:1750582052
Name:PITTSBORO FAMILY EYE CENTER
Entity type:Organization
Organization Name:PITTSBORO FAMILY EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:919-542-2020
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312
Mailing Address - Country:US
Mailing Address - Phone:919-542-2020
Mailing Address - Fax:
Practice Address - Street 1:425 WEST ST
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312
Practice Address - Country:US
Practice Address - Phone:919-542-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty