Provider Demographics
NPI:1629589122
Name:FOOTHILLS OPTOMETRY P.A.
Entity Type:Organization
Organization Name:FOOTHILLS OPTOMETRY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:FARIHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-322-1944
Mailing Address - Street 1:2266 US HIGHWAY 70 SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-5164
Mailing Address - Country:US
Mailing Address - Phone:828-322-1944
Mailing Address - Fax:828-324-0331
Practice Address - Street 1:2266 US HIGHWAY 70 SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-5164
Practice Address - Country:US
Practice Address - Phone:828-322-1944
Practice Address - Fax:828-324-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1722261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659395192OtherBLUE CROSS AND BLUE SHIELD
1659395192OtherCOMMUNITY EYE CARE