Provider Demographics
NPI:1285665448
Name:WASHINGTON EYE CLINIC, P.A.
Entity type:Organization
Organization Name:WASHINGTON EYE CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-946-2171
Mailing Address - Street 1:639 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3526
Mailing Address - Country:US
Mailing Address - Phone:252-946-2171
Mailing Address - Fax:252-946-5986
Practice Address - Street 1:639 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3526
Practice Address - Country:US
Practice Address - Phone:252-946-2171
Practice Address - Fax:252-946-5986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1057152W00000X
NC18081207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902876Medicaid
NC02876OtherBLUE CROSS BLUE SHIELD NC
NC230152OtherMEDICARE PTAN
NC02876OtherBLUE CROSS BLUE SHIELD NC