MEDICARE: SUSAN B. WISE, O.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DE9589	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1053337121	OTHER	NC	GROUP NPI
2	0261N	OTHER	NC	BCBSNC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053337121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN B. WISE, O.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 850
Second Line	:
City	:	MARS HILL
State	:	NC
Zip	:	28754-0850
Country	:	US
Telephone Number	:	828-689-4206
Fax Number	:	828-689-5007

Provider Business Practice Location Address
First Line	:	63 CHESTNUT ST
Second Line	:
City	:	MARS HILL
State	:	NC
Zip	:	28754-7542
Country	:	US
Telephone Number	:	828-689-4206
Fax Number	:	828-689-5007

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SUSAN WISE
Credential	:	O.D.
Telephone Number	:	828-689-4206

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	04/09/2009

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