Organization
PRIMARY VISION CARE CENTER, O.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP CARL TART O.D. (PRESIDENT)
(910) 803-0555
Entity
Organization
Contact information
Practice address
13520 NC HWY 50, SURF CITY, NC 28445
(910) 803-0555
(910) 338-3160
Mailing address
PO BOX 2429, SURF CITY, NC 28443-2149
(910) 803-0555
(910) 338-3160
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1127
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09890
BLUE CROSS BLUE SHIELD
NC
01
—
2200320
UNITED HEALTH CARE
NC
05
—
8909890
—
NC
Enumeration date
05/22/2007
Last updated
08/28/2013
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