Provider Demographics
NPI:1831157866
Name:UNIVERSITY EYE ASSOCIATES OD, PA
Entity type:Organization
Organization Name:UNIVERSITY EYE ASSOCIATES OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE BILLING & INSURANCE MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-547-1551
Mailing Address - Street 1:8316 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6702
Mailing Address - Country:US
Mailing Address - Phone:704-547-1551
Mailing Address - Fax:704-548-8017
Practice Address - Street 1:8316 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6702
Practice Address - Country:US
Practice Address - Phone:704-547-1551
Practice Address - Fax:704-548-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890901FMedicaid
NC0901FOtherBLUE CROSS BLUE SHIELD
NC890901FMedicaid
NC2468116Medicare PIN