Provider Demographics
NPI:1881952810
Name:GRAYSTONE OPHTHALMOLOGY ASSOCIATES, PA
Entity type:Organization
Organization Name:GRAYSTONE OPHTHALMOLOGY ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-322-2050
Mailing Address - Street 1:PO BOX 3445
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-3445
Mailing Address - Country:US
Mailing Address - Phone:828-304-6602
Mailing Address - Fax:828-345-0522
Practice Address - Street 1:2640 HIGHWAY 105 STE 102
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7828
Practice Address - Country:US
Practice Address - Phone:828-322-2050
Practice Address - Fax:828-345-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38977207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1774OtherBCBS
NC8901774Medicaid
NCA33892OtherEYEMED
NC4496151OtherAETNA
NCNC36626OtherWELLCARE