Provider Demographics
NPI:1821053059
Name:WATAUGA EYE CENTER, PA
Entity Type:Organization
Organization Name:WATAUGA EYE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-262-1554
Mailing Address - Street 1:150 MARKET HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-3678
Mailing Address - Country:US
Mailing Address - Phone:828-262-1554
Mailing Address - Fax:828-268-2981
Practice Address - Street 1:150 MARKET HILLS DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-3678
Practice Address - Country:US
Practice Address - Phone:828-262-1554
Practice Address - Fax:828-268-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7902495Medicaid
NC0319530001Medicare NSC
NC2344468Medicare PIN