Basic Information
| Provider Information | |||||||||
| NPI: | 1699722215 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOCTORS VISION CENTER OF ASHEVILLE OD PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DOCTORS VISION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12910 SHELBYVILLE RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402432404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022442420 | ||||||||
| FaxNumber: | 5029968282 | ||||||||
| Practice Location | |||||||||
| Address1: | 51 GASH FARM RD | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288052709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286815959 | ||||||||
| FaxNumber: | 2524672339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 03/04/2019 | ||||||||
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| AuthorizedOfficialLastName: | WARTMAN | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8282731946 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1269 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0233H | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 790233H | 05 | NC | MEDICAID |