Provider Demographics
NPI:1184778136
Name:CHARLES V. SIKES JR
Entity type:Organization
Organization Name:CHARLES V. SIKES JR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:V
Authorized Official - Last Name:SIKES
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:910-893-5711
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546
Mailing Address - Country:US
Mailing Address - Phone:910-893-5711
Mailing Address - Fax:910-893-4805
Practice Address - Street 1:210 W IVEY ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546
Practice Address - Country:US
Practice Address - Phone:910-893-5711
Practice Address - Fax:910-893-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09832OtherBCBSNC C. SIKES, JR.
NC8909827Medicaid
NC0157XOtherBCBSNC GROUP NUMBER
NC09713OtherBCBSNC L. SMITH
NC8909713Medicaid
NC890157XMedicaid
NC410000229OtherRR MEDICARE #
NC1505Medicare ID - Type UnspecifiedGROUP NUMBER
NC890157XMedicaid
NC0158090001Medicare NSC
NC2468088AMedicare ID - Type UnspecifiedLAURA L. SMITH OD
NCU35488Medicare UPIN
NC8909827Medicaid