Provider Demographics
NPI:1215981428
Name:BLUE RIDGE LASER EYE ASSOCIATES, P.A.
Entity type:Organization
Organization Name:BLUE RIDGE LASER EYE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GENEVA
Authorized Official - Middle Name:F
Authorized Official - Last Name:NELON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-894-3037
Mailing Address - Street 1:192 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-6418
Mailing Address - Country:US
Mailing Address - Phone:828-894-3037
Mailing Address - Fax:828-894-7041
Practice Address - Street 1:192 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-6418
Practice Address - Country:US
Practice Address - Phone:828-894-3037
Practice Address - Fax:828-894-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF8060OtherRAILROAD MEDICARE
NC2333605OtherMEDICARE GROUP
SC8597OtherMEDICARE GROUP
NC012REOtherBC/BS OF NORTH CAROLINA
SC8597OtherMEDICARE GROUP