Healthcare Provider Details

I. General information

NPI: 1174534648
Provider Name (Legal Business Name): MORGANTON EYE PHYSICIANS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 MALCOLM BOULEVARD OPTICAL DEPARTMENT
RUTHERFORD COLLEGE NC
28671
US

IV. Provider business mailing address

335 E PARKER RD OPTICAL DEPARTMENT
MORGANTON NC
28655-5112
US

V. Phone/Fax

Practice location:
  • Phone: 828-874-1000
  • Fax: 828-874-4142
Mailing address:
  • Phone: 828-433-1000
  • Fax: 828-433-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DENNIS W LEE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 828-433-1000