Provider Demographics
NPI:1801849302
Name:BARTLETT GRIGSBY BOAN & ASSOC PLLC
Entity Type:Organization
Organization Name:BARTLETT GRIGSBY BOAN & ASSOC PLLC
Other - Org Name:PEAK EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-878-2660
Mailing Address - Street 1:1060 LENOIR RHYNE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4330
Mailing Address - Country:US
Mailing Address - Phone:828-328-3900
Mailing Address - Fax:828-328-5253
Practice Address - Street 1:1060 LENOIR RHYNE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602
Practice Address - Country:US
Practice Address - Phone:828-328-3900
Practice Address - Fax:828-328-5253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1537152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890267NMedicaid
NC2469243HMedicare PIN
NC0807620003Medicare NSC