Provider Demographics
NPI:1801099338
Name:SIE EYECARE, O.D., P.A.
Entity type:Organization
Organization Name:SIE EYECARE, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:HAM
Authorized Official - Last Name:SIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-548-9888
Mailing Address - Street 1:1913 J N PEASE PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4556
Mailing Address - Country:US
Mailing Address - Phone:704-548-9888
Mailing Address - Fax:704-548-0077
Practice Address - Street 1:1913 J N PEASE PL
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4556
Practice Address - Country:US
Practice Address - Phone:704-548-9888
Practice Address - Fax:704-548-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1662152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2347363Medicare ID - Type Unspecified
5718450001Medicare NSC