=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821209867
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVERY EYE CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2007
-----------------------------------------------------
Last Update Date | 01/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 681 CRANBERRY ST
-----------------------------------------------------
City | NEWLAND
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28657-8801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-733-2011
-----------------------------------------------------
Fax | 828-733-6177
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 681 CRANBERRY ST
-----------------------------------------------------
City | NEWLAND
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28657-8801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-733-2011
-----------------------------------------------------
Fax | 828-733-6177
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST, OWNER
-----------------------------------------------------
Name | DR. ANDREW L WILLIAMS
-----------------------------------------------------
Credential | O.D
-----------------------------------------------------
Telephone | 828-733-2011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | NC1404
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------