Provider Demographics
NPI:1922493865
Name:WG HEFNER VAMC SALISBURY
Entity Type:Organization
Organization Name:WG HEFNER VAMC SALISBURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRY RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AYNSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRARDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-224-4549
Mailing Address - Street 1:1601 BRENNER AVE
Mailing Address - Street 2:BUILDING 3, FLOOR 2 OPTOMETRY
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 BRENNER AVE
Practice Address - Street 2:BUILDING 3, FLOOR 2 OPTOMETRY
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2515
Practice Address - Country:US
Practice Address - Phone:704-638-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty