Provider Demographics
NPI:1982649489
Name:CHAMPION, HAROLD A (OD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:A
Last Name:CHAMPION
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 1:300 JULIAN LN
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-7809
Mailing Address - Country:US
Mailing Address - Phone:828-650-2727
Mailing Address - Fax:282-650-2725
Practice Address - Street 1:300 JULIAN LN
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7809
Practice Address - Country:US
Practice Address - Phone:828-650-2727
Practice Address - Fax:828-650-2725
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1541152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2271057OtherUNITED HEALTHCARE
NC2469371EOtherMEDICARE ID
NC10717OtherBLUE CROSS BLUE SHIELD
NC114419OtherEYEMED
NC890910XMedicaid
NC7824373OtherCIGNA
NCNC01540OtherVISION BENEFITS OF AMERIC
NC1248120001OtherP TAN
NCU52014Medicare UPIN