Provider Demographics
NPI:1124683313
Name:CARDINAL EYE CARE OD
Entity type:Organization
Organization Name:CARDINAL EYE CARE OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:BUTTERWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:434-429-5868
Mailing Address - Street 1:409 LOTUS CT
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-9840
Mailing Address - Country:US
Mailing Address - Phone:434-429-5868
Mailing Address - Fax:
Practice Address - Street 1:3316 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3011
Practice Address - Country:US
Practice Address - Phone:336-765-5350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty