Healthcare Provider Details

I. General information

NPI: 1235192113
Provider Name (Legal Business Name): HORIZON EYE CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S SHARON AMITY RD SUITE 100
CHARLOTTE NC
28211-2842
US

IV. Provider business mailing address

PO BOX 60160
CHARLOTTE NC
28260-0160
US

V. Phone/Fax

Practice location:
  • Phone: 704-365-0555
  • Fax: 704-367-8122
Mailing address:
  • Phone: 704-365-0555
  • Fax: 704-367-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VICKY S HARMON
Title or Position: MANAGED CARE/CREDENTIALING COORD
Credential:
Phone: 704-405-4183