Basic Information
| Provider Information | |||||||||
| NPI: | 1790291219 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHAPEL HILL EYECARE, OD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 S ELLIOTT RD | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275145831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199684774 | ||||||||
| FaxNumber: | 9199425291 | ||||||||
| Practice Location | |||||||||
| Address1: | 235 S ELLIOTT RD | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275145831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199684774 | ||||||||
| FaxNumber: | 9199425291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2017 | ||||||||
| LastUpdateDate: | 12/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | SIKES | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 9105474020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | 2174 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.