Provider Demographics
NPI:1710984323
Name:ENDRY, PAUL JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:ENDRY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PAGE AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2382
Mailing Address - Country:US
Mailing Address - Phone:828-253-3533
Mailing Address - Fax:828-253-3389
Practice Address - Street 1:1 PAGE AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2382
Practice Address - Country:US
Practice Address - Phone:828-253-3533
Practice Address - Fax:828-253-3389
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1206152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9266Medicaid
NC246493FMedicare ID - Type Unspecified
NC9266Medicaid