Provider Demographics
NPI:1689695751
Name:GREENVILLE EYE CLINIC INC
Entity type:Organization
Organization Name:GREENVILLE EYE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-758-4166
Mailing Address - Street 1:2425 HEMBY LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3733
Mailing Address - Country:US
Mailing Address - Phone:252-758-4166
Mailing Address - Fax:252-758-5456
Practice Address - Street 1:2425 HEMBY LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3733
Practice Address - Country:US
Practice Address - Phone:252-758-4166
Practice Address - Fax:252-758-5456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherFEDERAL TAX ID