MEDICARE: NORTH STATE OPTICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	336	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01838	OTHER	NC	BCBS NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912978727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH STATE OPTICS INC

Provider Business Mailing Address
First Line	:	PO BOX 1168
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28359-1168
Country	:	US
Telephone Number	:	910-738-9335
Fax Number	:	910-738-2238

Provider Business Practice Location Address
First Line	:	4336 FAYETTEVILLE RD
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-2677
Country	:	US
Telephone Number	:	910-738-9335
Fax Number	:	910-738-2238

Authorized Official
Title or Position	:	PRESIDENT OF CORPORATION OPTICIAN
Name	:	MR. CHERRY BROUGHTON HILBURN
Credential	:
Telephone Number	:	910-738-9335

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	05/24/2013

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Directions to “NORTH STATE OPTICS INC ” Practice Location

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