MEDICARE: FOOTHILLS EYE CARE, O.D., P.A.

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	1560	NC
2	152W00000X	Optometrist	2057	NC

General Provider Information

NPI Number	:	1548530801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTHILLS EYE CARE, O.D., P.A.

Provider Business Mailing Address
First Line	:	215 MOORE RD
Second Line	:
City	:	KING
State	:	NC
Zip	:	27021-8703
Country	:	US
Telephone Number	:	336-985-2020
Fax Number	:	336-985-2133

Provider Business Practice Location Address
First Line	:	335 N MAIN ST
Second Line	:
City	:	WALNUT COVE
State	:	NC
Zip	:	27052-9200
Country	:	US
Telephone Number	:	336-591-7428
Fax Number	:	336-591-5136

Authorized Official
Title or Position	:	VP, SECRETARY, TREASURER
Name	:	DR. CANDICE C FIX
Credential	:	O.D.
Telephone Number	:	336-985-2020

Provider Enumeration Date	:	01/04/2012
Last Update Date	:	01/04/2012

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