Provider Demographics
NPI:1770565939
Name:GASTON EYE ASSOCIATES
Entity type:Organization
Organization Name:GASTON EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-922-9808
Mailing Address - Street 1:820 LOWER DALLAS HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-9368
Mailing Address - Country:US
Mailing Address - Phone:704-922-9808
Mailing Address - Fax:704-922-8213
Practice Address - Street 1:820 LOWER DALLAS HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-9368
Practice Address - Country:US
Practice Address - Phone:704-922-9808
Practice Address - Fax:704-922-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1826152W00000X
NC1048152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890185BMedicaid
NC0185BOtherBLUE CROSS
NC50344OtherMEDCOST
NC50344OtherMEDCOST
NC890185BMedicaid
NC2342432Medicare PIN