Provider Demographics
NPI:1366557803
Name:WHITE EYE ASSOCIATES PA
Entity type:Organization
Organization Name:WHITE EYE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:YAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-758-5800
Mailing Address - Street 1:301 BOWMAN GRAY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7204
Mailing Address - Country:US
Mailing Address - Phone:252-758-5800
Mailing Address - Fax:252-758-3226
Practice Address - Street 1:301 BOWMAN GRAY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7204
Practice Address - Country:US
Practice Address - Phone:252-758-5800
Practice Address - Fax:252-758-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7902931Medicaid
02931OtherBCBS OF NORTH CAROLINA
NC0828Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
NC7902931Medicaid