Provider Demographics
NPI:1912965989
Name:UNIVERSITY EYE ASSOCIATES, OD PA
Entity type:Organization
Organization Name:UNIVERSITY EYE ASSOCIATES, OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE BILLING & INSURANCE MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-547-1551
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8019
Mailing Address - Country:US
Mailing Address - Phone:704-896-9090
Mailing Address - Fax:704-896-9680
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8019
Practice Address - Country:US
Practice Address - Phone:704-896-9090
Practice Address - Fax:704-896-9680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014N9Medicaid
NC014PMOtherBLUE CROSS BLUE SHIELD
NC014PMOtherBLUE CROSS BLUE SHIELD
NC2468116AMedicare PIN