Healthcare Provider Details

I. General information

NPI: 1821053059
Provider Name (Legal Business Name): WATAUGA EYE CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MARKET HILLS DR
BOONE NC
28607-3678
US

IV. Provider business mailing address

150 MARKET HILLS DR
BOONE NC
28607-3678
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-1554
  • Fax: 828-268-2981
Mailing address:
  • Phone: 828-262-1554
  • Fax: 828-268-2981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIA H PERRY
Title or Position: OFFICE MANAGER
Credential:
Phone: 828-262-1554