Healthcare Provider Details

I. General information

NPI: 1659669281
Provider Name (Legal Business Name): AMMONS PERRY OPTOMETRIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 AIRPORT RD SUITE L
ARDEN NC
28704
US

IV. Provider business mailing address

140 AIRPORT RD SUITE L
ARDEN NC
28704
US

V. Phone/Fax

Practice location:
  • Phone: 828-687-7500
  • Fax: 828-687-7500
Mailing address:
  • Phone: 828-687-7500
  • Fax: 828-687-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2164
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number2164
License Number StateNC

VIII. Authorized Official

Name: DR. HALEY AMMONS PERRY
Title or Position: OWNER/OPERATOR
Credential: O.D.
Phone: 828-628-6700