Provider Demographics
NPI:1922140714
Name:GASTON EYE ASSOCIATES
Entity Type:Organization
Organization Name:GASTON EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE FOR DME
Authorized Official - Prefix:
Authorized Official - First Name:GASTON EYE ASSOCIATE
Authorized Official - Middle Name:DALLAS
Authorized Official - Last Name:DME
Authorized Official - Suffix:
Authorized Official - Credentials:DME
Authorized Official - Phone:704-922-9808
Mailing Address - Street 1:820 LOWER DALLAS HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-9368
Mailing Address - Country:US
Mailing Address - Phone:704-922-9808
Mailing Address - Fax:704-922-8213
Practice Address - Street 1:820 LOWER DALLAS HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-9368
Practice Address - Country:US
Practice Address - Phone:704-922-9808
Practice Address - Fax:704-922-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1048332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0846090003OtherPALMETTO