Healthcare Provider Details

I. General information

NPI: 1043336878
Provider Name (Legal Business Name): CHRISTOPHER K MAUNEY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 MAIN STREET
MCADENVILLE NC
28101-0308
US

IV. Provider business mailing address

PO BOX 308
MC ADENVILLE NC
28101-0308
US

V. Phone/Fax

Practice location:
  • Phone: 704-824-3401
  • Fax: 704-824-3727
Mailing address:
  • Phone: 704-824-3401
  • Fax: 704-824-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1685
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: