Provider Demographics
NPI:1992932016
Name:SUMMIT EYE CARE, P.A.
Entity type:Organization
Organization Name:SUMMIT EYE CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHEMSARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-765-0960
Mailing Address - Street 1:3073 TRENWEST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3207
Mailing Address - Country:US
Mailing Address - Phone:336-765-0960
Mailing Address - Fax:336-765-7453
Practice Address - Street 1:3073 TRENWEST DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3207
Practice Address - Country:US
Practice Address - Phone:336-765-0960
Practice Address - Fax:336-765-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01566207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910540Medicaid
NC5910540Medicaid
NC2023217AMedicare PIN