Provider Demographics
NPI:1689870131
Name:HENDERSONVILLE OPTICIANS
Entity Type:Organization
Organization Name:HENDERSONVILLE OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:828-693-6056
Mailing Address - Street 1:1733 BREVARD RD
Mailing Address - Street 2:LAUREL PARK VILLAGE
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3201
Mailing Address - Country:US
Mailing Address - Phone:828-693-6056
Mailing Address - Fax:828-693-5807
Practice Address - Street 1:1733 BREVARD RD
Practice Address - Street 2:LAUREL PARK VILLAGE
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3201
Practice Address - Country:US
Practice Address - Phone:828-693-6056
Practice Address - Fax:828-693-5807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC401332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8801702Medicaid