MEDICARE: GASTON EYE ASSOCIATES

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	1826	NC
2	152W00000X	Optometrist	1048	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0185B	OTHER	NC	BLUE CROSS
3	50344	OTHER	NC	MEDCOST

General Provider Information

NPI Number	:	1770565939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTON EYE ASSOCIATES

Provider Business Mailing Address
First Line	:	820 LOWER DALLAS HWY
Second Line	:
City	:	DALLAS
State	:	NC
Zip	:	28034-9368
Country	:	US
Telephone Number	:	704-922-9808
Fax Number	:	704-922-8213

Provider Business Practice Location Address
First Line	:	820 LOWER DALLAS HWY
Second Line	:
City	:	DALLAS
State	:	NC
Zip	:	28034-9368
Country	:	US
Telephone Number	:	704-922-9808
Fax Number	:	704-922-8213

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. RANDALL D HOLLAND
Credential	:	M.D.
Telephone Number	:	704-922-9808

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	08/07/2008

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Directions to “GASTON EYE ASSOCIATES ” Practice Location

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