Healthcare Provider Details

I. General information

NPI: 1063896777
Provider Name (Legal Business Name): METROLINA EYE ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6237 CAROLINA COMMONS DR SUITE 300
INDIAN LAND SC
29707-6014
US

IV. Provider business mailing address

630 COMFORT LN SUITE E
MONROE NC
28112-6199
US

V. Phone/Fax

Practice location:
  • Phone: 804-547-3937
  • Fax:
Mailing address:
  • Phone: 704-289-5455
  • Fax: 704-291-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE GOVE
Title or Position: ASST. PRACTICE ADMINISTRATOR
Credential:
Phone: 704-774-1180