=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053645002
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAROSLAV J. CERNY JR. O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2009
-----------------------------------------------------
Last Update Date | 09/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 SARDIS RD
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28806-8536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-665-0603
-----------------------------------------------------
Fax | 828-665-0676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 SARDIS ROAD
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28806-8536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-665-0603
-----------------------------------------------------
Fax | 828-665-0676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0866
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------