Provider Demographics
NPI:1811933401
Name:CHAMPION, PATRICIA P
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:P
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 MEDICAL PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-4188
Mailing Address - Country:US
Mailing Address - Phone:828-884-7320
Mailing Address - Fax:
Practice Address - Street 1:188 MEDICAL PARK DR STE C
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4188
Practice Address - Country:US
Practice Address - Phone:828-884-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2019-11-05
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
NC2271058OtherUNITED HEALTHCARE
NCNC01541OtherVISION BENEFITS OF AMERIC
NC114419OtherEYEMED
NC890911XMedicaid
NC1329153OtherCIGNA
NC10716OtherBLUE CROSS BLUE SHIELD
NC2271058OtherUNITED HEALTHCARE
NC890911XMedicaid
NC1248120001Medicare NSC