FRED S CLONINGER OD (NPI# 1235539099) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235539099 |
| Entity Type | Organization |
| Organization Name | FRED S CLONINGER OD |
| Other Organization Name | BROAD STREET VISION CENTER |
| Practice Address |
406 S Broad St Suite A Gastonia NC 28054-4304 |
| Practice Telephone | 7048653731 |
| Practice Fax Number | 7048645736 |
| Mailing Telephone | 7048653731 |
| Mailing Fax Number | 7048645736 |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2014-08-29 |
| Authorized Official Name | FRED S CLONINGER (OWNER) |
| Authorized Official Telephone | 70418653731 |
| Is Organization Subpart | Y |
| Parent Organization Name | FRED S CLONINGER OD |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | 0804 | NC | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 8909163 | 05 |
| Other Name | Type Code |
|---|---|
| Broad Street Vision Center | Doing Business As Name - Organization |
| Street Address |
406 S BROAD ST SUITE A |
| City | GASTONIA |
| State | NC |
| Zip Code | 28054-4304 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508965161 | Fred S Cloninger | Optometrist | 406 S Broad St, Suite A, Gastonia, NC 28054-4304 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225671423 | Michaela Karsyn Morris | Behavioral Analyst | 2875 Court Dr. B, Gastonia, NC 28054 | 2019-10-21 |
| 1982263810 | Brenda Sue Fox | Occupational Therapist | Brian Center, 969 Cox Rd, Gastonia, NC 28054 | 2019-06-13 |
| 1174096911 | Carolinas Hometown Respiratory LLC | Durable Medical Equipment & Medical Supplies | 469 Hospital Drive, Suite B1, Gastonia, NC 28054 | 2019-01-04 |
| 1255801817 | Jarae Mcswain | Counselor | 1558 Union Road, Ste F, Gastonia, NC 28054 | 2018-11-27 |
| 1427549807 | Alterman & Dhillon Charlotte Metro, Pplc | Dentist | 2205 E. Franklin Blvd, Ste 110, Gastonia, NC 28054 | 2018-05-22 |
| 1871083147 | Terrence Lamont Campbell | Dentist | 2641 Court Dr Ste A, Gastonia, NC 28054 | 2018-05-13 |
| 1861995367 | Jefferson and Jefferson LLC. | Respite Care | 945 East 6 Ave, Gastonia, NC 28054 | 2018-03-12 |
| 1790154912 | Tyler Adcock | Pharmacist | 2324 South New Hope Rd, Gastonia, NC 28054 | 2015-09-17 |
| 1922481894 | Alesha Nicole Logan | Nurse Practitioner | 1895 Hoffman Rd Ste A, Gastonia, NC 28054 | 2015-07-09 |
| 1457732596 | Buffie Baker Eller | Counselor | 2005 Flint Lane, Gastonia, NC 28054 | 2015-06-15 |
| Find all providers in zip 28054 | ||||
| Taxonomy Code | 332H00000X |
| Grouping | Suppliers |
| Classification | Eyewear Supplier (Equipment, not the service) |
| An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346875028 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 3916 E Franklin Blvd Ste 160, Gastonia, NC 28056-9220 | 2020-03-03 |
| 1306910740 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 250 N New Hope Rd, Gastonia, NC 28054-4714 | 2006-11-18 |
| 1427005610 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | 3000 E Franklin Blvd, Gastonia, NC 28056-9451 | 2006-05-31 |
| 1679615462 | Gaston Eye Associates | Eyewear Supplier (Equipment, not the service) | 2325 Aberdeen Blvd, Ste A, Gastonia, NC 28054-0614 | 2007-02-12 |
| 1578618153 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 246 N New Hope Rd, Gastonia, NC 28054-4977 | 2007-01-24 |
| 1417945775 | Gaston Eye Associates | Eyewear Supplier (Equipment, not the service) | 2325 Aberdeen Blvd, Ste A, Gastonia, NC 28054-0614 | 2005-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982202966 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 1433 Boone Station Dr, Burlington, NC 27215-8229 | 2020-10-13 |
| 1053918599 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 6301 Triangle Plantation Dr, Raleigh, NC 27616-5174 | 2020-10-07 |
| 1609483841 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 255 Shenstone Ln, Garner, NC 27529-6906 | 2020-09-30 |
| 1619584000 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 7905 Lyles Ln Nw, Concord, NC 28027-7111 | 2020-09-29 |
| 1174130041 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 141 Gallery Center Dr, Mooresville, NC 28117-6307 | 2020-09-25 |
| 1013524909 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 8811 Brier Creek Pkwy, Raleigh, NC 27617-7585 | 2020-09-25 |
| 1063029098 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 2370 Walnut St, Cary, NC 27518-9210 | 2020-09-24 |
| 1114534120 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 11715 Carolina Place Pkwy, Pineville, NC 28134-8819 | 2020-09-24 |
| 1093326514 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 4010 Durham Chapel Hill Blvd Ste 400, Durham, NC 27707-2425 | 2020-08-10 |
| 1740820513 | Horizon Eye Care, Pa | Eyewear Supplier (Equipment, not the service) | 10834 Mallard Creek Road, Charlotte, NC 28262-9786 | 2020-01-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.