Healthcare Provider Details

I. General information

NPI: 1639372998
Provider Name (Legal Business Name): HORIZON EYE CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 SOUTHMORE DR
CHARLOTTE NC
28277-4819
US

IV. Provider business mailing address

PO BOX 60160
CHARLOTTE NC
28260-0160
US

V. Phone/Fax

Practice location:
  • Phone: 704-341-3220
  • Fax: 704-341-3692
Mailing address:
  • Phone: 704-365-0555
  • Fax: 704-367-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VICKY HARMON
Title or Position: MANAGED CARE COORDINATOR
Credential:
Phone: 704-405-4183