Healthcare Provider Details

I. General information

NPI: 1871696740
Provider Name (Legal Business Name): WESTERN CAROLINA EYE ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 MEDICAL PARK DR
JEFFERSON NC
28640-9561
US

IV. Provider business mailing address

610 STATE FARM RD SUITE A
BOONE NC
28607-4738
US

V. Phone/Fax

Practice location:
  • Phone: 336-246-3937
  • Fax:
Mailing address:
  • Phone: 828-264-0042
  • Fax: 828-264-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1704
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number31161
License Number StateNC

VIII. Authorized Official

Name: MS. KATHY ELIZABETH CASE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 828-264-0042