Healthcare Provider Details

I. General information

NPI: 1043739691
Provider Name (Legal Business Name): OCULUS EYE CARE, O.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7860 REA RD
CHARLOTTE NC
28277-6502
US

IV. Provider business mailing address

9716 REA RD STE B-529
CHARLOTTE NC
28277-6663
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-3937
  • Fax:
Mailing address:
  • Phone: 980-785-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2437
License Number StateNC

VIII. Authorized Official

Name: DR. MARY E BOWEN
Title or Position: PRESIDENT
Credential: OD
Phone: 980-785-3937