1982649489 NPI number — DR. HAROLD A CHAMPION OD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982649489 NPI number — DR. HAROLD A CHAMPION OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAMPION
Provider First Name:
HAROLD
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982649489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 JULIAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARDEN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28704-7809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-650-2727
Provider Business Mailing Address Fax Number:
282-650-2725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 JULIAN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28704-7809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-650-2727
Provider Business Practice Location Address Fax Number:
828-650-2725
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1541 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2271057 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2469371E . This is a "MEDICARE ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 10717 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 114419 . This is a "EYEMED" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890910X , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7824373 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NC01540 . This is a "VISION BENEFITS OF AMERIC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1248120001 . This is a "P TAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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