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General NPI Number Information
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NPI Number | 1376609818
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Entity Type | Organization
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Legal Business Name | WILMINGTON EYE CARE ASSOCIATES OD
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 6825 PARKER FARM DR
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City | WILMINGTON
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State | NC
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Zip | 28405-3168
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Country | US
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Telephone | 910-452-0554
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Fax | 910-452-0767
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Provider Business Mailing Address
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Address Line | 7100 SIX FORKS RD SUITE 301
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City | RALEIGH
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State | NC
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Zip | 27615-6156
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Country | US
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Telephone | 919-847-0187
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Fax | 919-676-2231
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN BOLICK
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Credential | OD
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Telephone | 919-847-0187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1294
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License Number State | NC
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