Provider Demographics
NPI:1427124643
Name:CAROLINA PEDIATRIC EYE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:CAROLINA PEDIATRIC EYE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BUHILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-795-5588
Mailing Address - Street 1:1025 VINEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2439
Mailing Address - Country:US
Mailing Address - Phone:704-795-5588
Mailing Address - Fax:704-795-5591
Practice Address - Street 1:1025 VINEHAVEN DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2439
Practice Address - Country:US
Practice Address - Phone:704-795-5588
Practice Address - Fax:704-795-5591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701485332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911296Medicaid
NCF96805Medicare UPIN
NC2252599AMedicare PIN
NC8911296Medicaid