Healthcare Provider Details

I. General information

NPI: 1548884984
Provider Name (Legal Business Name): EYECARECENTER OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MOORE RD
KING NC
27021-8703
US

IV. Provider business mailing address

PO BOX 207261
DALLAS TX
75320-7261
US

V. Phone/Fax

Practice location:
  • Phone: 336-985-2020
  • Fax:
Mailing address:
  • Phone: 636-200-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALISON BAILEY
Title or Position: OWNER
Credential: OD
Phone: 636-200-4393