Provider Demographics
NPI:1154739563
Name:EYECARECENTER OD PA
Entity type:Organization
Organization Name:EYECARECENTER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-200-4393
Mailing Address - Street 1:PO BOX 207261
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7261
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:190 INDEPENDENCE AVE STE A
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4270
Practice Address - Country:US
Practice Address - Phone:336-667-6782
Practice Address - Fax:336-667-7968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYECARECENTER OD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-29
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02AUGOtherBCBSNC
NC0222680033OtherSUPPLIER NUMBER
NC1154739563Medicaid
NC1154739563Medicaid
NC2467887Medicare PIN