Provider Demographics
NPI:1215984331
Name:MID-ATLANTIC EYE PHYSICIANS, PA
Entity type:Organization
Organization Name:MID-ATLANTIC EYE PHYSICIANS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRICHLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-537-8193
Mailing Address - Street 1:204 BECKER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3134
Mailing Address - Country:US
Mailing Address - Phone:252-537-8193
Mailing Address - Fax:252-537-0589
Practice Address - Street 1:204 BECKER DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3134
Practice Address - Country:US
Practice Address - Phone:252-537-8193
Practice Address - Fax:252-537-0589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01858OtherBCBS OF NC
VA332641OtherANTHEM BCBS
VA332642OtherANTHEM BCBS
0347580002Medicare NSC
NC1684Medicare PIN
VA332642OtherANTHEM BCBS
NCCD8982Medicare PIN
VACD8980Medicare PIN