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General NPI Number Information
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NPI Number | 1780716902
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Entity Type | Organization
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Legal Business Name | ENVISION EYECARE OD PA
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 180 CHARLOTTE ST
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City | ASHEVILLE
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State | NC
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Zip | 28801-1923
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Country | US
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Telephone | 828-254-6757
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Fax | 828-254-6758
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Provider Business Mailing Address
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Address Line | 180 CHARLOTTE ST
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City | ASHEVILLE
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State | NC
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Zip | 28801-1923
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Country | US
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Telephone | 828-254-6757
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Fax | 828-254-6758
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Authorized Official
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Title or Position | OWNER
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Name | DR. LARRY SHANE GOLSON
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Credential | O.D.
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Telephone | 828-254-6757
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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 | 1890
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License Number State | NC
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