Provider Demographics
NPI:1437212057
Name:WESTERN NC OPTOMETRIC GROUP PA
Entity Type:Organization
Organization Name:WESTERN NC OPTOMETRIC GROUP PA
Other - Org Name:TUNNEL VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-298-6500
Mailing Address - Street 1:4 SOUTH TUNNEL ROAD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805
Mailing Address - Country:US
Mailing Address - Phone:828-298-6500
Mailing Address - Fax:828-298-9108
Practice Address - Street 1:4 SOUTH TUNNEL ROAD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805
Practice Address - Country:US
Practice Address - Phone:828-298-6500
Practice Address - Fax:828-298-9108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1927064OtherUNITED HEALTHCARE
NC5472150001OtherDMERC REGION C
NC89013HFMedicaid
NC1927064OtherUNITED HEALTHCARE
NC5472150001OtherDMERC REGION C