Broad Street Vision Center

LBN: Fred S Cloninger Od
Broad Street Vision Center is an health care organization with primary practice located at 406 S Broad St Suite A, Gastonia NC 28054-4304. The organization recently has only one registered license in Suppliers / Eyewear Supplier (Equipment, not the service), which is considered as the primary health care specialty. Fred S Cloninger Od can be contacted via phone (704) 865-3731, or through Cloninger, Fred S via phone 70418653731.

Contact Information

Primary practice address
406 S Broad St Suite A Gastonia NC 28054-4304
Phone: (704) 865-3731
Fax: (704) 864-5736
Website:
Map and Directions
Authorized official contact:
Name: Cloninger, Fred S
Phone: 70418653731

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Eyewear Supplier (Equipment, not the service) 332H00000X 0804 North Carolina

Profile Details

NPI number 1235539099
LBN Legal business name Fred S Cloninger Od
DBA Doing business as Broad Street Vision Center
Authorized official Cloninger, Fred S
Entity Organization
Organization subpart 1 Yes
Enumeration date Aug 29th, 2014
Last updated Aug 29th, 2014 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235539099 NPPES
North Carolina MEDICAID 8909163

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