Provider Demographics
NPI:1841226610
Name:HALIFAX EYE CENTER PA
Entity type:Organization
Organization Name:HALIFAX EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HASHMAT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-537-0522
Mailing Address - Street 1:608A JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-2656
Mailing Address - Country:US
Mailing Address - Phone:252-537-0522
Mailing Address - Fax:252-537-3644
Practice Address - Street 1:608A JACKSON ST
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2656
Practice Address - Country:US
Practice Address - Phone:252-537-0522
Practice Address - Fax:252-537-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27035207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890195EMedicaid
NCDG7954OtherRAILROAD MEDICARE
NC0915EOtherNC BCBS
NCC46396Medicare UPIN
NC890195EMedicaid
NC0313510001Medicare NSC