1225174865 NPI number — DR. LASHETA P. DAVID O.D.

Table of content: KRISTY MURPHY PHARMD (NPI 1023462967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225174865 NPI number — DR. LASHETA P. DAVID O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVID
Provider First Name:
LASHETA
Provider Middle Name:
P.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRICE
Provider Other First Name:
LASHETA
Provider Other Middle Name:
D.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225174865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6167 BAYFIELD PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28027-7486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-795-3937
Provider Business Mailing Address Fax Number:
704-795-1577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6167 BAYFIELD PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28027-7486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-795-3937
Provider Business Practice Location Address Fax Number:
704-795-1577
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1068 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 1647 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 093H3 . This is a "HEALTHCHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 651317623 . This is a "SUPERIOR VISION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890915N , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: OP2772 . This is a "EYEMED VISION CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 093H3 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 25386 . This is a "OPTICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1190 . This is a "COMMUNITY EYE CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 48263 . This is a "AVESIS (WELLPATH)" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 562053819 . This is a "SUPERIOR VISION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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