Provider Demographics
NPI:1306083803
Name:AHOSKIE EYE CARE OD PA DBA WINDSOR EYE CARE
Entity type:Organization
Organization Name:AHOSKIE EYE CARE OD PA DBA WINDSOR EYE CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-332-2020
Mailing Address - Street 1:P.O. BOX 160
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-6863
Mailing Address - Country:US
Mailing Address - Phone:252-794-3381
Mailing Address - Fax:252-794-3371
Practice Address - Street 1:106 N KING STREET
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-6863
Practice Address - Country:US
Practice Address - Phone:252-794-3381
Practice Address - Fax:252-794-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-09-22
Deactivation Date:2009-06-05
Deactivation Code:
Reactivation Date:2009-07-15
Provider Licenses
StateLicense IDTaxonomies
NCNC1332152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950660Medicaid
NC8802140Medicaid