Provider Demographics
NPI:1164458220
Name:BROSNAN EYE ASSOCIATES
Entity Type:Organization
Organization Name:BROSNAN EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:HAWKINS
Authorized Official - Last Name:BROSNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-254-9693
Mailing Address - Street 1:900 CENTREPARK DRIVE
Mailing Address - Street 2:STE A
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805
Mailing Address - Country:US
Mailing Address - Phone:828-254-9693
Mailing Address - Fax:828-254-9695
Practice Address - Street 1:900 CENTREPARK DRIVE
Practice Address - Street 2:STE A
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805
Practice Address - Country:US
Practice Address - Phone:828-254-9693
Practice Address - Fax:828-254-9695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900380Medicaid
NC017A2OtherBLUE CROSS BLUE SHIELD NC
NC5900380Medicaid
NC017A2OtherBLUE CROSS BLUE SHIELD NC
NC2323677Medicare PIN