Provider Demographics
NPI:1215049291
Name:EYE CONSULTANTS OF GREENSBORO
Entity type:Organization
Organization Name:EYE CONSULTANTS OF GREENSBORO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:336-389-0242
Mailing Address - Street 1:1305 W WENDOVER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8124
Mailing Address - Country:US
Mailing Address - Phone:336-389-0242
Mailing Address - Fax:336-389-0263
Practice Address - Street 1:1305 W WENDOVER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8124
Practice Address - Country:US
Practice Address - Phone:336-389-0242
Practice Address - Fax:336-389-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26482156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912204Medicaid
NCB76311Medicare UPIN
NC2275873AMedicare ID - Type Unspecified