Provider Demographics
NPI:1508029539
Name:CAROLINA OPTOMETRIC OF ARDEN PA
Entity Type:Organization
Organization Name:CAROLINA OPTOMETRIC OF ARDEN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-681-8000
Mailing Address - Street 1:2145 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-9723
Mailing Address - Country:US
Mailing Address - Phone:828-681-8000
Mailing Address - Fax:828-681-0990
Practice Address - Street 1:2145 HENDERSONVILLE RD
Practice Address - Street 2:SUITE D
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-9723
Practice Address - Country:US
Practice Address - Phone:828-681-8000
Practice Address - Fax:828-681-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1243152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4306620001OtherDMERC
NC2333100OtherMEDICARE