Provider Demographics
NPI:1427291053
Name:VILLAGE EYE CARE OPTOMETRY, PLLC
Entity type:Organization
Organization Name:VILLAGE EYE CARE OPTOMETRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:BATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-828-2078
Mailing Address - Street 1:2113 CAMERON ST
Mailing Address - Street 2:STE 240
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1394
Mailing Address - Country:US
Mailing Address - Phone:919-828-2078
Mailing Address - Fax:919-833-9835
Practice Address - Street 1:2113 CAMERON ST
Practice Address - Street 2:STE 240
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1394
Practice Address - Country:US
Practice Address - Phone:919-828-2078
Practice Address - Fax:919-833-9835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1434152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8802129Medicaid
NC8802129Medicaid