Provider Demographics
NPI:1609106939
Name:WATAUGA EYE CENTER PA
Entity type:Organization
Organization Name:WATAUGA EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:COT
Authorized Official - Phone:828-262-1554
Mailing Address - Street 1:150 MARKET HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-3678
Mailing Address - Country:US
Mailing Address - Phone:828-262-1554
Mailing Address - Fax:828-268-2981
Practice Address - Street 1:436 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LINVILLE
Practice Address - State:NC
Practice Address - Zip Code:28646
Practice Address - Country:US
Practice Address - Phone:828-737-7720
Practice Address - Fax:828-737-7729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0319530003Medicare NSC
NC2344468Medicare PIN