Provider Demographics
NPI:1548530801
Name:FOOTHILLS EYE CARE, O.D., P.A.
Entity type:Organization
Organization Name:FOOTHILLS EYE CARE, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, SECRETARY, TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FIX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-985-2020
Mailing Address - Street 1:215 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-8703
Mailing Address - Country:US
Mailing Address - Phone:336-985-2020
Mailing Address - Fax:336-985-2133
Practice Address - Street 1:335 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT COVE
Practice Address - State:NC
Practice Address - Zip Code:27052-9200
Practice Address - Country:US
Practice Address - Phone:336-591-7428
Practice Address - Fax:336-591-5136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1560152W00000X
NC2057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty