Provider Demographics
NPI:1184641813
Name:BATTLEGROUND EYE CARE, OD, PA
Entity Type:Organization
Organization Name:BATTLEGROUND EYE CARE, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-282-2273
Mailing Address - Street 1:3132 BATTLEGROUND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-1915
Mailing Address - Country:US
Mailing Address - Phone:336-282-2273
Mailing Address - Fax:336-282-5325
Practice Address - Street 1:3132 BATTLEGROUND AVE STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-1915
Practice Address - Country:US
Practice Address - Phone:336-282-2273
Practice Address - Fax:336-282-5325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015XEMedicaid
NC2340094Medicare PIN