Provider Demographics
NPI:1407308059
Name:MOUNTAIN EYE ASSOCIATES, PLLC.
Entity Type:Organization
Organization Name:MOUNTAIN EYE ASSOCIATES, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-452-5816
Mailing Address - Street 1:486 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8026
Mailing Address - Country:US
Mailing Address - Phone:828-452-5816
Mailing Address - Fax:
Practice Address - Street 1:137 MEDICAL PARK LOOP
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5222
Practice Address - Country:US
Practice Address - Phone:828-477-4572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890256VMedicaid