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General NPI Number Information
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NPI Number | 1043739691
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Entity Type | Organization
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Legal Business Name | OCULUS EYE CARE, O.D., P.A.
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 09/14/2017
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Provider Practice Location Address
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Address Line | 7860 REA RD
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City | CHARLOTTE
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State | NC
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Zip | 28277-6502
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Country | US
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Telephone | 980-785-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 9716 REA RD STE B-529
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City | CHARLOTTE
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State | NC
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Zip | 28277-6663
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Country | US
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Telephone | 980-785-3937
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY E BOWEN
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Credential | OD
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Telephone | 980-785-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2437
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License Number State | NC
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