1164458220 NPI number — BROSNAN EYE ASSOCIATES

Table of content: MRS. CORTNEY SHANA GRIFFIN APN (NPI 1407366164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164458220 NPI number — BROSNAN EYE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROSNAN EYE ASSOCIATES
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:
1164458220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 CENTREPARK DRIVE
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-254-9693
Provider Business Mailing Address Fax Number:
828-254-9695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 CENTREPARK DRIVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-254-9693
Provider Business Practice Location Address Fax Number:
828-254-9695
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROSNAN
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
HAWKINS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
828-254-9693

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5900380 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017A2 . This is a "BLUE CROSS BLUE SHIELD NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com