MEDICARE: DR. CHARLES VAN SIKES JR. O.D.

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	0997	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	410014665	OTHER	NC	RAILROAD MEDICARE SANFORD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410000229	OTHER	NC	RAILROAD MDCR LILLINGTON
2	0158090001	OTHER	NC	PALMETTO LILLINGTON
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	09832	OTHER	NC	BCBS OF NC
6	09832	OTHER	NC	BCBS LILLINGTON

General Provider Information

NPI Number	:	1619925724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES VAN SIKES JR. O.D.

Provider Business Mailing Address
First Line	:	120 JOHNSON ST
Second Line	:
City	:	BROADWAY
State	:	NC
Zip	:	27505-9503
Country	:	US
Telephone Number	:	919-258-9203
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 CARTHAGE ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-8984
Country	:	US
Telephone Number	:	919-774-3556
Fax Number	:	919-774-7356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	11/25/2009

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