Healthcare Provider Details

I. General information

NPI: 1902057920
Provider Name (Legal Business Name): SIAD INC A NC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SARDIS RD
ASHEVILLE NC
28806-8536
US

IV. Provider business mailing address

17 SARDIS RD
ASHEVILLE NC
28806-8536
US

V. Phone/Fax

Practice location:
  • Phone: 828-665-0603
  • Fax:
Mailing address:
  • Phone: 828-665-0603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT C BISHOP JR.
Title or Position: OWNER
Credential:
Phone: 828-665-0603