Provider Demographics
NPI:1962698365
Name:COLE, JULIE A (OD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:COLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:BLACKSMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:312 E CENTERVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-2553
Mailing Address - Country:US
Mailing Address - Phone:704-857-5464
Mailing Address - Fax:704-857-6732
Practice Address - Street 1:312 E CENTERVIEW ST
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28023-2553
Practice Address - Country:US
Practice Address - Phone:704-857-5464
Practice Address - Fax:704-857-6732
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0802152W00000X
MA4731152W00000X
NC2106152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110082554AMedicaid
MA001098901Medicare PIN