Healthcare Provider Details

I. General information

NPI: 1740820513
Provider Name (Legal Business Name): HORIZON EYE CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10834 MALLARD CREEK ROAD
CHARLOTTE NC
28262-9786
US

IV. Provider business mailing address

PO BOX 60160
CHARLOTTE NC
28260-0160
US

V. Phone/Fax

Practice location:
  • Phone: 704-717-0058
  • Fax: 704-717-0333
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 SESSOMS HARMON
Title or Position: MANAGED CARE COORDINATOR
Credential:
Phone: 704-405-4183