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General NPI Number Information
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NPI Number | 1104572213
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Entity Type | Organization
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Legal Business Name | NC DOCTORS OF OPTOMETRY PLLC
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 9882 REA RD STE A
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City | CHARLOTTE
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State | NC
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Zip | 28277-6715
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Country | US
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Telephone | 704-627-8143
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Fax |
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Provider Business Mailing Address
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Address Line | 175 E HOUSTON ST
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2299
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Country | US
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Telephone | 726-444-4078
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Fax |
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Authorized Official
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Title or Position | OD/OWNER
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Name | JASON L HENDRIX
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Credential |
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Telephone | 910-520-6951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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