Provider Demographics
NPI:1770815722
Name:KERNERSVILLE EYE ASSOCIATES, O.D., P.A.
Entity type:Organization
Organization Name:KERNERSVILLE EYE ASSOCIATES, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SUBRAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FAAO
Authorized Official - Phone:336-992-0010
Mailing Address - Street 1:1635 NC HIGHWAY 66 S STE 155
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3855
Mailing Address - Country:US
Mailing Address - Phone:336-992-0010
Mailing Address - Fax:336-245-4636
Practice Address - Street 1:1030 S MAIN ST
Practice Address - Street 2:SUITE Q
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7490
Practice Address - Country:US
Practice Address - Phone:336-992-0010
Practice Address - Fax:336-245-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905630Medicaid
7866788OtherAETNA US HEALTHCARE
NC807938OtherPARTNERS NATIONAL HEALTH PLAN
093U1OtherBCBS OF NC
2630870OtherUNITED HEALTHCARE
NCP00450033OtherPALMETTO GBA RAILROAD MEDICARE
NC807938OtherPARTNERS NATIONAL HEALTH PLAN
NC2473983AMedicare PIN