Provider Demographics
NPI:1740239276
Name:WISE, VALERIE (OD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:WISE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JANE JACOBS RD STE 103B
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-6306
Mailing Address - Country:US
Mailing Address - Phone:828-669-1191
Mailing Address - Fax:828-669-6024
Practice Address - Street 1:15 JANE JACOBS RD STE 103B
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-6306
Practice Address - Country:US
Practice Address - Phone:828-669-1191
Practice Address - Fax:828-669-6024
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909997Medicaid