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NPI Code Detail

MEDICARE: EYECARE SPECIALTIES OF NORTH CAROLINA OD PLLC

MEDICARE: EYECARE SPECIALTIES OF NORTH CAROLINA OD PLLC
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1699483586
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYECARE SPECIALTIES OF NORTH CAROLINA OD PLLC
Provider Business Mailing Address
First Line : 111 E 4TH ST STE 440
Second Line :
City : ALTON
State : IL
Zip : 62002-6241
Country : US
Telephone Number : 618-462-9818
Fax Number : 314-741-4947
Provider Business Practice Location Address
First Line : 504 VILLAGE WALK DR
Second Line :
City : HOLLY SPRINGS
State : NC
Zip : 27540-4440
Country : US
Telephone Number : 919-351-8600
Fax Number : 314-741-4947
Authorized Official
Title or Position : SR. DIR. RCM/MVC
Name : MELISSA ALLISON
Credential :
Telephone Number : 618-462-9818
Provider Enumeration Date : 11/09/2022
Last Update Date : 01/24/2024

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