Provider Demographics
NPI:1982959862
Name:EYE CENTER OF THE CAROLINAS, PC
Entity Type:Organization
Organization Name:EYE CENTER OF THE CAROLINAS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:KOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-449-1333
Mailing Address - Street 1:709 GOLF HOUSE RD E
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-9217
Mailing Address - Country:US
Mailing Address - Phone:336-420-4706
Mailing Address - Fax:336-449-1348
Practice Address - Street 1:709 GOLFHOUSE ROAD EAST
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9748
Practice Address - Country:US
Practice Address - Phone:336-420-4706
Practice Address - Fax:336-449-1348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301373207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB544Medicare PIN