Basic Information
| Provider Information | |||||||||
| NPI: | 1790736106 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHAPEL HILL EYE CARE AND OPTOMETRY PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHAPEL HILL EYE CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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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: | 05/12/2006 | ||||||||
| LastUpdateDate: | 12/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | STICE | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | RAY | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY FOR CORPORATION | ||||||||
| AuthorizedOfficialTelephone: | 9199684774 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0152Q | 01 | NC | BCBS OF NC | OTHER |