Provider Demographics
NPI:1912978727
Name:NORTH STATE OPTICS INC
Entity Type:Organization
Organization Name:NORTH STATE OPTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:BROUGHTON
Authorized Official - Last Name:HILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-738-9335
Mailing Address - Street 1:PO BOX 1168
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-1168
Mailing Address - Country:US
Mailing Address - Phone:910-738-9335
Mailing Address - Fax:910-738-2238
Practice Address - Street 1:4336 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2677
Practice Address - Country:US
Practice Address - Phone:910-738-9335
Practice Address - Fax:910-738-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC336156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01838OtherBCBS NC
NC8801750Medicaid
NC0643920001Medicare NSC