Healthcare Provider Details

I. General information

NPI: 1982959862
Provider Name (Legal Business Name): EYE CENTER OF THE CAROLINAS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 GOLFHOUSE ROAD EAST
WHITSETT NC
27377-9748
US

IV. Provider business mailing address

709 GOLF HOUSE RD E
WHITSETT NC
27377-9217
US

V. Phone/Fax

Practice location:
  • Phone: 336-420-4706
  • Fax: 336-449-1348
Mailing address:
  • Phone: 336-420-4706
  • Fax: 336-449-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number200301373
License Number StateNC

VIII. Authorized Official

Name: DR. PAUL V KOWALSKI
Title or Position: OWNER
Credential: MD
Phone: 336-449-1333