BROAD STREET VISION CENTER
NPI 1235539099
Eyewear Supplier in Gastonia, NC

Q: What is Fred S Cloninger Od's NPI number?

The NPI number for Fred S Cloninger Od is 1235539099. It was assigned to this organization in the NPPES registry on August 29, 2014. The provider is doing business as Broad Street Vision Center.

Q: What is Fred S Cloninger Od's specialty?

The primary specialty registered for this NPI is Eyewear Supplier with taxonomy code 332H00000X.

Active since August 29, 2014

406 S BROAD ST, SUITE A, GASTONIA, NC 28054(704) 865-3731(704) 864-5736 Get Directions Write a Review

NPPES record last updated: August 29, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Broad Street Vision Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BROAD STREET VISION CENTER (NPI 1235539099) is a healthcare organization registered as an eyewear supplier in Gastonia, North Carolina and active in the NPI registry since August 2014. The organization lists Fred S Cloninger, Owner, as its authorized official.

NPPES Registry Identity

NPI1235539099

Entity TypeOrganization

Primary Taxonomy332H00000X

Legal Business NameFRED S CLONINGER OD

Location Address406 S BROAD ST, SUITE AGastonia, NC 28054-4304

Mailing Address406 S Broad St, Suite AGastonia, NC 28054-4304 · (704) 865-3731 · Fax (704) 864-5736

Phone(704) 865-3731

Fax(704) 864-5736

Organization SubpartYes

Authorized OfficialFred S CloningerOwner · 70418653731

Enumeration DateAugust 29, 2014

✔ NPI 1235539099 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEyewear SupplierSuppliers

Taxonomy Code332H00000X

License✔ Licensed in NC · 0804

Definition

An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

406 S BROAD ST, Gastonia, NC 28054

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Other Names 1

Doing Business AsBroad Street Vision Center

Other Identifiers 2

Medicaid8909163NC

Medicare PIN0554550001NC

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FRED S CLONINGER OD

Optometrist

406 S BROAD ST, SUITE A
GASTONIA, NC 28054

Gaston County (704) 865-3731

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fred S Cloninger Od's NPI number?

The NPI number for Fred S Cloninger Od is 1235539099. It was assigned to this organization in the NPPES registry on August 29, 2014. The provider is doing business as Broad Street Vision Center.

Where is Fred S Cloninger Od located?

Fred S Cloninger Od is located at 406 S Broad St Suite A, Gastonia, NC 28054. The listed phone number is (704) 865-3731.

What is Fred S Cloninger Od's specialty?

The primary specialty registered for this NPI is Eyewear Supplier with taxonomy code 332H00000X.

When was this NPI record last updated?

The NPPES record for Fred S Cloninger Od was last updated on August 29, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.