Provider Demographics
NPI:1235323130
Name:WNC EYE CARE ASSOCIATES PA OPTICAL DEPARTMENT
Entity Type:Organization
Organization Name:WNC EYE CARE ASSOCIATES PA OPTICAL DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUCHEMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-586-7462
Mailing Address - Street 1:70 WESTCARE DR.
Mailing Address - Street 2:STE 404
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5279
Mailing Address - Country:US
Mailing Address - Phone:828-586-4151
Mailing Address - Fax:828-586-8121
Practice Address - Street 1:70 WESTCARE DR
Practice Address - Street 2:STE 404
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5292
Practice Address - Country:US
Practice Address - Phone:828-586-4151
Practice Address - Fax:828-586-8121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WNC EYE CARE ASSOCIATES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-04
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1575332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8802103Medicaid
NC1053980002Medicare NSC