MEDICARE: EYECARECENTER OD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02AUG	OTHER	NC	BCBSNC
2	0222680033	OTHER	NC	SUPPLIER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154739563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYECARECENTER OD PA

Provider Business Mailing Address
First Line	:	PO BOX 207261
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-7261
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	190 INDEPENDENCE AVE STE A
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-4270
Country	:	US
Telephone Number	:	336-667-6782
Fax Number	:	336-667-7968

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	DR. ALISON BAILEY
Credential	:	OD
Telephone Number	:	636-200-4393

Provider Enumeration Date	:	07/29/2014
Last Update Date	:	02/24/2025

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