Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2421 | NC |
NPI | 1013314608 |
---|---|
Provider Name | Dr. Ashley Ballard |
First Address | Vienna, VA 22182-3970 |
Second Address | Fayetteville, NC 28314-3219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2014 |
Last Update Date | 22/09/2021 |