MEDICARE: CENTRAL CAROLINA SURGICAL EYE ASSOCIATES, 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	207W00000X	Ophthalmology Physician		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01257	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811994031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL CAROLINA SURGICAL EYE ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 38157
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27438-8157
Country	:	US
Telephone Number	:	336-282-5000
Fax Number	:	336-482-3778

Provider Business Practice Location Address
First Line	:	3312 BATTLEGROUND AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2402
Country	:	US
Telephone Number	:	336-282-5000
Fax Number	:	336-482-3778

Authorized Official
Title or Position	:	HR MANAGER
Name	:	MS. SUSAN M RUSH
Credential	:
Telephone Number	:	336-282-5000

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/21/2022

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