Organization Active NPI

Eyecarecenter OD PA

  • Optometrist
  • Elizabeth City, NC
National Provider Identifier
1902859952
Registry record updated Sep 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYECARECENTER OD PA
Practice address
1813 W Ehringhaus St
Elizabeth City, NC 27909-4555
Phone
(636) 200-4393
Fax
(252) 333-1796
NPI assigned
May 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2023

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

Authorized official

Name
Dr. Alison Bailey, OD
Title
Owner
Phone
(636) 200-4393

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

1813 W Ehringhaus St
Elizabeth City, NC 27909-4555

Mailing address

PO Box 207261
Dallas, TX 75320-7261
Phone (636) 200-4393

Other identifiers 3

IdentifierTypeStateIssuer
890236WMedicaidNC
CA8262OtherNCRR MEDICARE GROUP
0236WOtherNCBCBSNC GROUP NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040318001780 NC Part B Supplier - Clinic/Group Practice 7315834462 Receives reassigned benefits from 137 practitioners
42 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 40

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 40

National Provider Directory

National Provider Directory

Locations

1813 W Ehringhaus St
Elizabeth Cty, NC 27909
Phone (252) 333-1155

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695945600000",
    "number": "1902859952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207261",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753207261",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 W EHRINGHAUS ST",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279094555",
            "telephone_number": "636-200-4393",
            "fax_number": "252-333-1796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARECENTER OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "ALISON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-200-4393",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890236W",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP",
            "identifier": "CA8262",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC GROUP NUMBER",
            "identifier": "0236W",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.