Healthcare Provider Details

I. General information

NPI: 1467357350
Provider Name (Legal Business Name): BRONWYN MCKEEN LDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 THE PLZ STE B
CHARLOTTE NC
28215-2098
US

IV. Provider business mailing address

8404 VERMILION DR
CHARLOTTE NC
28215-9553
US

V. Phone/Fax

Practice location:
  • Phone: 704-568-6760
  • Fax: 704-568-6760
Mailing address:
  • Phone: 704-568-6760
  • Fax: 704-568-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number1163
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1163
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: