Organization
EYESTAT OPTOMETRIC SERVICES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH RICHARD STATSICK OD (OWNER)
(813) 385-4738
Entity
Organization
Contact information
Practice address
720 PONDFIELD RD, PRINCETON, NC 27569
(813) 385-4738
Mailing address
720 PONDFIELD RD, PRINCETON, NC 27569
(813) 385-4738
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2303
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407162043
NPI
FL
Enumeration date
04/16/2013
Last updated
06/10/2013
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