Basic Information
| Provider Information | |||||||||
| NPI: | 1003149113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIKES | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2174 | NC | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 703 | HI | N | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 5914407 | 05 | NC | MEDICAID |