Provider Demographics
NPI:1265485791
Name:BARTLETT GRIGSBY BOAN & ASSOC PLLC
Entity Type:Organization
Organization Name:BARTLETT GRIGSBY BOAN & ASSOC PLLC
Other - Org Name:PEAK EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-878-2660
Mailing Address - Street 1:843 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3222
Mailing Address - Country:US
Mailing Address - Phone:704-878-2660
Mailing Address - Fax:704-878-2636
Practice Address - Street 1:843 N CENTER ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677
Practice Address - Country:US
Practice Address - Phone:704-878-2660
Practice Address - Fax:704-878-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1039152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890280TMedicaid
NC2469243FMedicare PIN
NC0807620001Medicare NSC