Provider Demographics
NPI:1427245786
Name:CHAPEL HILL EYE CARE ASSOCIATES, OD PLLC
Entity type:Organization
Organization Name:CHAPEL HILL EYE CARE ASSOCIATES, OD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-847-0187
Mailing Address - Street 1:7100 SIX FORKS RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6156
Mailing Address - Country:US
Mailing Address - Phone:919-847-0187
Mailing Address - Fax:919-676-2231
Practice Address - Street 1:1201 RALEIGH RD
Practice Address - Street 2:SUITE E
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-4047
Practice Address - Country:US
Practice Address - Phone:919-942-3320
Practice Address - Fax:919-942-7268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1279152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDP8183OtherRAILROAD MEDICARE
NC020VKOtherBLUE CROSS BS
NC5950261Medicaid
NC020VKOtherBLUE CROSS BS
NC2335822Medicare PIN