Healthcare Provider Details

I. General information

NPI: 1013963719
Provider Name (Legal Business Name): GENESIS EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 EAST MOREHEAD STREET SUITE 200
CHARLOTTE NC
28202-2767
US

IV. Provider business mailing address

817 EAST MOREHEAD STREET SUITE 200
CHARLOTTE NC
28202-2767
US

V. Phone/Fax

Practice location:
  • Phone: 704-295-0001
  • Fax: 704-295-0002
Mailing address:
  • Phone: 704-295-0001
  • Fax: 704-295-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GALEN GRAYSON
Title or Position: OWNER
Credential: MD
Phone: 704-295-0001