Provider Demographics
NPI:1881752319
Name:ASHEVILLE OPTOMETRIC GROUP PA
Entity type:Organization
Organization Name:ASHEVILLE OPTOMETRIC GROUP PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-252-5255
Mailing Address - Street 1:701 MERRIMON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804
Mailing Address - Country:US
Mailing Address - Phone:828-252-5255
Mailing Address - Fax:828-254-4299
Practice Address - Street 1:701 MERRIMON AVENUE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804
Practice Address - Country:US
Practice Address - Phone:828-252-5255
Practice Address - Fax:828-254-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890923GMedicaid
NC0923GOtherBLUE CROSS BLUE SHIELD
NC1927064OtherUNITED HEALTH CARE
NC5472150001OtherDEMERK MEDICARE AGENCY
NC890923GMedicaid
NC0923GOtherBLUE CROSS BLUE SHIELD