Eyestat Optometric Services, P.a.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2303 Issued in NC

Legal business name

EYESTAT OPTOMETRIC SERVICES, P.A.

Practice address

720 Pondfield Rd
Princeton, NC 27569

Phone

(813) 385-4738

NPI assigned

Apr 16, 2013

Last updated

Jun 10, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kenneth Richard Statsick, OD

Title

Owner

Phone

(813) 385-4738

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sarah C. Statsick, OD

  • Optometrist
  • Goldsboro, NC
  • NPI 1598557944
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370822400000",
    "number": "1093158404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 PONDFIELD RD",
            "city": "PRINCETON",
            "state": "NC",
            "postal_code": "27569",
            "telephone_number": "813-385-4738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 PONDFIELD RD",
            "city": "PRINCETON",
            "state": "NC",
            "postal_code": "27569",
            "telephone_number": "813-385-4738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYESTAT OPTOMETRIC SERVICES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-16",
        "last_updated": "2013-06-10",
        "status": "A",
        "authorized_official_last_name": "STATSICK",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-385-4738",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1407162043",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Princeton, NC
• Providers in Princeton, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.