Provider Demographics
NPI:1366580441
Name:F. Y. EYE CARE ASSOCIATES, OPTOMETRISTS, PA
Entity type:Organization
Organization Name:F. Y. EYE CARE ASSOCIATES, OPTOMETRISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-875-8787
Mailing Address - Street 1:6714 FORTESCUE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-2102
Mailing Address - Country:US
Mailing Address - Phone:704-509-0328
Mailing Address - Fax:
Practice Address - Street 1:10210 PROSPERITY PARK DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1103
Practice Address - Country:US
Practice Address - Phone:704-875-8787
Practice Address - Fax:704-871-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1797152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905821Medicaid
NC5887810001Medicare NSC
NC2343385Medicare PIN