Healthcare Provider Details

I. General information

NPI: 1306083803
Provider Name (Legal Business Name): AHOSKIE EYE CARE OD PA DBA WINDSOR EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date: 06/05/2009
Reactivation Date: 07/15/2009

III. Provider practice location address

106 N KING STREET
WINDSOR NC
27983-6863
US

IV. Provider business mailing address

P.O. BOX 160
WINDSOR NC
27983-6863
US

V. Phone/Fax

Practice location:
  • Phone: 252-794-3381
  • Fax: 252-794-3371
Mailing address:
  • Phone: 252-794-3381
  • Fax: 252-794-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberNC1332
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNC1332
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5950660
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier8802140
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: DR. BRAD ERIC HAUSER
Title or Position: PRESIDENT/OPTOMETRIST
Credential: O.D.
Phone: 252-332-2020