Healthcare Provider Details

I. General information

NPI: 1023066040
Provider Name (Legal Business Name): ROCKINGHAM EYE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 THOMPSON ST SUITE A
EDEN NC
27288-5068
US

IV. Provider business mailing address

515 THOMPSON STREET SUITE A
EDEN NC
27288-5068
US

V. Phone/Fax

Practice location:
  • Phone: 336-627-5271
  • Fax:
Mailing address:
  • Phone: 336-627-5271
  • Fax: 336-623-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number26004
License Number StateNC

VIII. Authorized Official

Name: DR. CARROLL F HAINES JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 336-627-5271