1245248673 NPI number — MORGANTON EYE PHYSICIANS, P.A.

Table of content: (NPI 1245248673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245248673 NPI number — MORGANTON EYE PHYSICIANS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORGANTON EYE PHYSICIANS, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245248673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
335 E PARKER RD
Provider Second Line Business Mailing Address:
OPTICAL DEPARTMENT
Provider Business Mailing Address City Name:
MORGANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28655-5112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-433-1000
Provider Business Mailing Address Fax Number:
828-433-6274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
335 E PARKER RD
Provider Second Line Business Practice Location Address:
OPTICAL DEPARTMENT
Provider Business Practice Location Address City Name:
MORGANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28655-5112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-433-1000
Provider Business Practice Location Address Fax Number:
828-433-6274
Provider Enumeration Date:
08/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
W
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
828-433-1000

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8802039 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".