=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275936700
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISION CENTRAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2014
-----------------------------------------------------
Last Update Date | 09/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2709 CENTRAL AVE
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28205-5336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-375-5585
-----------------------------------------------------
Fax | 704-375-5586
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2709 CENTRAL AVE
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28205-5336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-375-5585
-----------------------------------------------------
Fax | 704-375-5586
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. KAREN ALEXANDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-375-5585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | NC876
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------