Provider Demographics
NPI:1659669281
Name:AMMONS PERRY OPTOMETRIC, PLLC
Entity Type:Organization
Organization Name:AMMONS PERRY OPTOMETRIC, PLLC
Other - Org Name:VISUAL EYES OPTOMETRIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:AMMONS
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-628-6700
Mailing Address - Street 1:140 AIRPORT RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704
Mailing Address - Country:US
Mailing Address - Phone:828-687-7500
Mailing Address - Fax:828-687-7333
Practice Address - Street 1:140 AIRPORT RD
Practice Address - Street 2:SUITE L
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704
Practice Address - Country:US
Practice Address - Phone:828-687-7500
Practice Address - Fax:828-687-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2164152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918512Medicaid
A644Medicare PIN
NCDS6875Medicare PIN
6583700001Medicare NSC