Provider Demographics
NPI:1639142656
Name:GREENSBORO OPHTHALMOLOGY ASC LLC
Entity Type:Organization
Organization Name:GREENSBORO OPHTHALMOLOGY ASC LLC
Other - Org Name:SURGICAL EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:APPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-255-2070
Mailing Address - Street 1:3312 BATTLEGROUND AVENUE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2402
Mailing Address - Country:US
Mailing Address - Phone:336-282-8331
Mailing Address - Fax:336-282-2625
Practice Address - Street 1:3312 BATTLEGROUND AVENUE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2402
Practice Address - Country:US
Practice Address - Phone:336-282-8331
Practice Address - Fax:336-282-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAS0033261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC490004996OtherRAILROAD MEDICARE
NC3409924Medicaid
VA7603762Medicaid
NC490004996OtherRAILROAD MEDICARE
VA7603762Medicaid