Basic Information
Provider Information
NPI: 1003149113
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SIKES
FirstName: JOSHUA
MiddleName: SCOTT
NamePrefix: DR.
NameSuffix:  
Credential: OD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 235 S ELLIOTT RD
Address2:  
City: CHAPEL HILL
State: NC
PostalCode: 275145831
CountryCode: US
TelephoneNumber: 9199684774
FaxNumber: 9194925291
Practice Location
Address1: 235 S ELLIOTT RD
Address2:  
City: CHAPEL HILL
State: NC
PostalCode: 275145831
CountryCode: US
TelephoneNumber: 9199684774
FaxNumber: 9194925291
Other Information
ProviderEnumerationDate: 09/09/2009
LastUpdateDate: 03/10/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X703HIN Eye and Vision Services ProvidersOptometrist 
152W00000X2174NCY Eye and Vision Services ProvidersOptometrist 

ID Information
IDTypeStateIssuerDescription
591440705NC MEDICAID


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