Gaston Eye Associates
Organization Active NPI Optometrist · Dallas, NC
NPI 1770565939 · NPPES record last updated Aug 7, 2008
Key facts
- NPI
- 1770565939
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 1048 (NC)
- Legal business name
- GASTON EYE ASSOCIATES
- Practice address
- 820 Lower Dallas Hwy
Dallas, NC 28034-9368 - Phone
- (704) 922-9808
- Fax
- (704) 922-8213
- NPI assigned
- Nov 15, 2005
- Organization subpart
- No
Authorized official
- Name
- Dr. Randall D Holland, M.D.
- Title
- Partner
- Phone
- (704) 922-9808
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 3
Practitioners 11
-
Joshua W Baker, O.D.
-
John Philip Foster, O.D.
-
Daniel Paul Lee, D.O.
-
John A Lowery, MD
-
Michael James Lund, M.D.
-
Nicole Lynch, O.D.
-
Nima Mazhari, O.D.
-
Robert Lee Sullivan, O.D.
-
Martin Todd Brown, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040920001050 | NC | Part B Supplier - Clinic/Group Practice | 7618945437 |
Receives reassigned benefits from 11 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Gastonia, NC; Dallas, NC |
| O20110907001503 | NC | DME Supplier - Physician - Optometrist | 7618945437 | Practice locations: Dallas, NC |
National Provider Directory
- Tax ID family
- Gaston Eye Associates
Locations
820 Lower Dallas Hwy
Dallas, NC 28034
Phone (704) 922-9808
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 1048 | NC | Yes |
| Optometrist |
152W00000X | 1826 | NC |
Addresses
Primary practice location
820 Lower Dallas Hwy
Dallas, NC 28034-9368
Mailing address
820 Lower Dallas Hwy
Dallas, NC 28034-9368
Phone (704) 922-9808
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 890185B | Medicaid | NC | |
| 0185B | Other | NC | BLUE CROSS |
| 50344 | Other | NC | MEDCOST |
Other providers in Dallas, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.