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General NPI Number Information
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NPI Number | 1922140714
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Entity Type | Organization
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Legal Business Name | GASTON EYE ASSOCIATES
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 820 LOWER DALLAS HWY
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City | DALLAS
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State | NC
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Zip | 28034-9368
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Country | US
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Telephone | 704-922-9808
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Fax | 704-922-8213
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Provider Business Mailing Address
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Address Line | 820 LOWER DALLAS HWY
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City | DALLAS
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State | NC
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Zip | 28034-9368
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Country | US
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Telephone | 704-922-9808
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Fax | 704-922-8213
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Authorized Official
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Title or Position | OFFICE FOR DME
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Name | GASTON EYE ASSOCIATE DALLAS DME
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Credential | DME
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Telephone | 704-922-9808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1048
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License Number State | NC
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