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General NPI Number Information
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NPI Number | 1366267023
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Entity Type | Organization
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Legal Business Name | CAROLINA VISION REHABILITATION OD PLLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 13749 STEELE CREEK RD STE B
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City | CHARLOTTE
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State | NC
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Zip | 28273-6841
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Country | US
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Telephone | 980-613-0919
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Fax |
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Provider Business Mailing Address
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Address Line | 13749 STEELE CREEK RD STE B
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City | CHARLOTTE
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State | NC
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Zip | 28273-6841
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Country | US
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Telephone | 980-613-0919
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Fax |
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Authorized Official
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Title or Position | DR./OWNER
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Name | DR. ANGELA BERGIN
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Credential | OD
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Telephone | 980-613-0919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number |
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License Number State |
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