MEDICARE: GREENSBORO OPHTHALMOLOGY ASC LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	AS0033	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	490004996	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639142656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENSBORO OPHTHALMOLOGY ASC LLC

Provider Business Mailing Address
First Line	:	3312 BATTLEGROUND AVENUE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2402
Country	:	US
Telephone Number	:	336-282-8331
Fax Number	:	336-282-2625

Provider Business Practice Location Address
First Line	:	3312 BATTLEGROUND AVENUE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2402
Country	:	US
Telephone Number	:	336-282-8331
Fax Number	:	336-282-2625

Authorized Official
Title or Position	:	MANAGER
Name	:	DAWN D APPLE
Credential	:
Telephone Number	:	910-255-2070

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	08/17/2018

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