Provider Demographics
NPI:1427227024
Name:ASHE OPTOMETRIC EYECARE CENTER, PA
Entity Type:Organization
Organization Name:ASHE OPTOMETRIC EYECARE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:336-246-8863
Mailing Address - Street 1:PO BOX 1477
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694
Mailing Address - Country:US
Mailing Address - Phone:336-246-8863
Mailing Address - Fax:336-246-8864
Practice Address - Street 1:306 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694
Practice Address - Country:US
Practice Address - Phone:336-246-8863
Practice Address - Fax:336-246-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1174152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909820Medicaid
NC10346-1OtherMEDPOINT
NC09820OtherBLUE CROSS BLUE SHEILD
NC56162OtherMEDCOST
NC8909820Medicaid
NC0729760001Medicare NSC
NC10346-1OtherMEDPOINT