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General NPI Number Information
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NPI Number | 1760500177
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Entity Type | Organization
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Legal Business Name | ANDY AND PATTY CHAMPION OD PA
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 300 JULIAN LN
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City | ARDEN
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State | NC
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Zip | 28704-7809
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Country | US
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Telephone | 828-650-2727
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Fax | 828-650-2725
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Provider Business Mailing Address
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Address Line | 300 JULIAN LN
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City | ARDEN
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State | NC
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Zip | 28704-7809
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Country | US
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Telephone | 828-650-2727
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Fax | 828-650-2725
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICIA P CHAMPION
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Credential | OD
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Telephone | 828-650-2727
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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 | 1541
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License Number State | NC
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