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General NPI Number Information
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NPI Number | 1205471430
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Entity Type | Organization
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Legal Business Name | WISE OPTOMETRY ASSOCIATES PA
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 15 JANE JACOBS RD STE 103B
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City | BLACK MOUNTAIN
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State | NC
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Zip | 28711-6306
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Country | US
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Telephone | 828-669-1191
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Fax | 828-669-6024
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Provider Business Mailing Address
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Address Line | 15 JANE JACOBS RD STE 103B
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City | BLACK MOUNTAIN
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State | NC
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Zip | 28711-6306
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Country | US
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Telephone | 828-669-1191
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Fax | 828-669-6024
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VALERIE L WISE
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Credential | OD
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Telephone | 704-507-0955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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