Provider Demographics
NPI:1295770980
Name:BLUE RIDGE EYE CARE, OD, PA
Entity type:Organization
Organization Name:BLUE RIDGE EYE CARE, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-698-3423
Mailing Address - Street 1:176 FOUR SEASONS MALL
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-2878
Mailing Address - Country:US
Mailing Address - Phone:828-698-3423
Mailing Address - Fax:828-693-4686
Practice Address - Street 1:176 FOUR SEASONS MALL
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2878
Practice Address - Country:US
Practice Address - Phone:828-698-3423
Practice Address - Fax:828-693-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC018ANOtherBCBS
NCU93449Medicare UPIN
NC5727710001Medicare NSC
NC2472764CMedicare PIN