NPIMap

Organization Active NPI

Triad Eye Associates of Asheboro OD PA

  • Optometrist
  • Asheboro, NC
National Provider Identifier
1205894292
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
TRIAD EYE ASSOCIATES OF ASHEBORO OD PA
Practice address
328A N Fayetteville St
Asheboro, NC 27203-5531
Phone
(336) 625-2020
Fax
(336) 629-2030
NPI assigned
May 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. James M Kernodle, ODNPI 1154326528
Title
Owner
Phone
(336) 625-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

328A N Fayetteville St
Asheboro, NC 27203-5531

Mailing address

328A N Fayetteville St
Asheboro, NC 27203-5531
Phone (336) 625-2020

Other identifiers 2

IdentifierTypeStateIssuer
89016FJMedicaidNC
011ENOtherNCBCBS/NC

National Provider Directory

National Provider Directory

Locations

328 N Fayetteville St
Ste A
Asheboro, NC 27203
Phone (336) 625-2020

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205894292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "328A N FAYETTEVILLE ST",
            "city": "ASHEBORO",
            "state": "NC",
            "postal_code": "272035531",
            "telephone_number": "336-625-2020",
            "fax_number": "336-629-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "328A N FAYETTEVILLE ST",
            "city": "ASHEBORO",
            "state": "NC",
            "postal_code": "272035531",
            "telephone_number": "336-625-2020",
            "fax_number": "336-629-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD EYE ASSOCIATES OF ASHEBORO OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KERNODLE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-625-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016FJ",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS/NC",
            "identifier": "011EN",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Asheboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.