Provider Demographics
NPI:1528253853
Name:FIX, CANDICE CAIN (OD)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:CAIN
Last Name:FIX
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2349
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-2349
Mailing Address - Country:US
Mailing Address - Phone:336-296-0012
Mailing Address - Fax:336-217-8833
Practice Address - Street 1:141 SPRUCE PINE WAY STE C
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-8445
Practice Address - Country:US
Practice Address - Phone:336-296-0012
Practice Address - Fax:336-217-8833
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP02558233OtherMEC RR MCARE PTAN
NC02G7HOtherMEC BCBS PROV #
NC2474441OtherKING MEDICARE PROV #
NCP00828722OtherRAILROAD MEDICARE
NC9511065OtherMEC AETNA PROV#
NCNC2057OtherMEC EYEMED PROV #
NC2474441OtherKING MEDICARE PROV #