Healthcare Provider Details

I. General information

NPI: 1609177435
Provider Name (Legal Business Name): MOUNTAIN EYE ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 PARK ST
CANTON NC
28716-4323
US

IV. Provider business mailing address

486 HOSPITAL DR
CLYDE NC
28721-8026
US

V. Phone/Fax

Practice location:
  • Phone: 825-648-2483
  • Fax: 828-648-4689
Mailing address:
  • Phone: 828-452-5816
  • Fax: 828-452-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID MARKOFF
Title or Position: OWNER
Credential:
Phone: 828-452-5816