Provider Demographics
NPI:1710111281
Name:ANSON FAMILY OPTOMETRIC, P.L.L.C.
Entity Type:Organization
Organization Name:ANSON FAMILY OPTOMETRIC, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:KIKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-694-3618
Mailing Address - Street 1:1134 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2452
Mailing Address - Country:US
Mailing Address - Phone:704-694-3618
Mailing Address - Fax:704-694-6446
Practice Address - Street 1:1134 HOLLY ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2452
Practice Address - Country:US
Practice Address - Phone:704-694-3618
Practice Address - Fax:704-694-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6576930001Medicare NSC