Provider Demographics
NPI:1003912452
Name:MIDDLETON, JOE W (OD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:W
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-0683
Mailing Address - Country:US
Mailing Address - Phone:828-437-2629
Mailing Address - Fax:828-437-2617
Practice Address - Street 1:407 E UNION ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3470
Practice Address - Country:US
Practice Address - Phone:828-437-2629
Practice Address - Fax:828-437-2617
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09603OtherBCBS
NC09603OtherBCBS
T64854Medicare UPIN
246309Medicare ID - Type Unspecified