Healthcare Provider Details

I. General information

NPI: 1861465205
Provider Name (Legal Business Name): CAROLINA EYE PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/04/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 MAPLE AVE
BURLINGTON NC
27215-5934
US

IV. Provider business mailing address

420 MAPLE AVE
BURLINGTON NC
27215-5934
US

V. Phone/Fax

Practice location:
  • Phone: 336-228-7877
  • Fax: 336-228-7514
Mailing address:
  • Phone: 336-228-7877
  • Fax: 336-228-7514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number335E00000X
License Number StateNC

VIII. Authorized Official

Name: MRS. ANNA BOYD JEFFERSON
Title or Position: PRESIDENT
Credential: BCO
Phone: 336-228-7877