Provider Demographics
NPI:1730325473
Name:APEX VISION CENTER OD PA
Entity type:Organization
Organization Name:APEX VISION CENTER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-367-7889
Mailing Address - Street 1:1049 BEAVER CREEK COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3918
Mailing Address - Country:US
Mailing Address - Phone:919-367-7889
Mailing Address - Fax:919-249-4079
Practice Address - Street 1:1049 BEAVER CREEK COMMONS DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3918
Practice Address - Country:US
Practice Address - Phone:919-367-7889
Practice Address - Fax:919-249-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950746Medicaid
NC2347305Medicare PIN
NC6462070001Medicare NSC