Provider Demographics
NPI:1427248707
Name:PORT CITY EYE ASSOCIATES, OD, P.A.
Entity type:Organization
Organization Name:PORT CITY EYE ASSOCIATES, OD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABBIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PREVATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-947-6285
Mailing Address - Street 1:8262 MARKET ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9805
Mailing Address - Country:US
Mailing Address - Phone:910-686-3396
Mailing Address - Fax:910-686-3398
Practice Address - Street 1:8262 MARKET ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9805
Practice Address - Country:US
Practice Address - Phone:910-686-3396
Practice Address - Fax:910-686-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2010-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699866145OtherNPI-PERSONAL
NC89093RUMedicaid
NC093RUOtherBCBS
NCU99114OtherUPIN
1699866145OtherNPI-PERSONAL