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General NPI Number Information
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NPI Number | 1992932016
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Entity Type | Organization
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Legal Business Name | SUMMIT EYE CARE, P.A.
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 3073 TRENWEST DR
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3207
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Country | US
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Telephone | 336-765-0960
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Fax | 336-765-7453
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Provider Business Mailing Address
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Address Line | 3073 TRENWEST DR
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3207
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Country | US
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Telephone | 336-765-0960
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Fax | 336-765-7453
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICKAS KHEMSARA
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Credential | M.D.
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Telephone | 336-765-0960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 2008-01566
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License Number State | NC
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