Organization
MEDICAL EYE ASSOCIATES PA
Active
Organization
MEDICAL EYE ASSOCIATES PA
Active
Other names
Wilson Optical
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN C PUTNAM MD (PARTNER/PRESIDENT)
(252) 443-6129
Entity
Organization
Contact information
Practice address
1707 MEDICAL PARK DR W, STE1, WILSON, NC 27893-2768
(252) 291-7008
(252) 291-1281
Mailing address
1707 MEDICAL PARK DR W, STE1, WILSON, NC 27893-2768
(252) 291-7008
(252) 291-1281
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073659769
NPI JOHN E THORDSEN
NC
01
—
1093V
BC
—
01
—
1180L
BC
—
01
—
12630
BC
—
01
—
180041781
RR MEDICARE
—
01
—
180041942
RR MEDICARE
—
01
—
180044388
RR MEDICARE
—
01
—
180641778
RR MEDICARE
—
01
—
190041779
RR MEDICARE
—
01
—
22680
BC
—
01
—
37986
BC
—
01
—
P00720248
RAILROAD MCEDICARE
—
Enumeration date
09/26/2005
Last updated
07/14/2014
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