Provider Demographics
NPI:1225174865
Name:DAVID, LASHETA P (OD)
Entity Type:Individual
Prefix:DR
First Name:LASHETA
Middle Name:P
Last Name:DAVID
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LASHETA
Other - Middle Name:D
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6167 BAYFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7486
Mailing Address - Country:US
Mailing Address - Phone:704-795-3937
Mailing Address - Fax:704-795-1577
Practice Address - Street 1:6167 BAYFIELD PKWY
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7486
Practice Address - Country:US
Practice Address - Phone:704-795-3937
Practice Address - Fax:704-795-1577
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1068152W00000X
NC1647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093H3OtherHEALTHCHOICE
NC651317623OtherSUPERIOR VISION
NC890915NMedicaid
NCOP2772OtherEYEMED VISION CARE
NC093H3OtherBLUE CROSS BLUE SHIELD OF
NC25386OtherOPTICARE
NC1190OtherCOMMUNITY EYE CARE
NC48263OtherAVESIS (WELLPATH)
NC562053819OtherSUPERIOR VISION
NC093H3OtherHEALTHCHOICE
NC562053819OtherSUPERIOR VISION