1437212057 NPI number — WESTERN NC OPTOMETRIC GROUP PA

Table of content: (NPI 1437212057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437212057 NPI number — WESTERN NC OPTOMETRIC GROUP PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN NC OPTOMETRIC GROUP PA
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:
6
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:
1437212057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 SOUTH TUNNEL ROAD
Provider Second Line Business Mailing Address:
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:
828-298-6500
Provider Business Mailing Address Fax Number:
828-298-9108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 SOUTH TUNNEL ROAD
Provider Second Line Business Practice Location Address:
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:
828-298-6500
Provider Business Practice Location Address Fax Number:
828-298-9108
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEWTON
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
828-298-6500

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1927064 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5472150001 . This is a "DMERC REGION C" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89013HF , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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