Provider Demographics
NPI:1841528213
Name:FAMILY EYECARE OF APEX
Entity type:Organization
Organization Name:FAMILY EYECARE OF APEX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-367-8411
Mailing Address - Street 1:113 SALEM TOWNE CT
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-2311
Mailing Address - Country:US
Mailing Address - Phone:919-367-8411
Mailing Address - Fax:919-367-8431
Practice Address - Street 1:113 SALEM TOWNE CT
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-2311
Practice Address - Country:US
Practice Address - Phone:919-367-8411
Practice Address - Fax:919-367-8431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890908CMedicaid
NCU72404Medicare UPIN
NC2471095FMedicare PIN