=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548409824
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOUBLE VISION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2009
-----------------------------------------------------
Last Update Date | 02/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6801 NORTHLAKE MALL DR SUITE 150
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28216-0711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-598-4300
-----------------------------------------------------
Fax | 704-598-4326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6801 NORTHLAKE MALL DR SUITE 150
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28216-0711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-598-4300
-----------------------------------------------------
Fax | 704-598-4326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER/ OPTICIAN
-----------------------------------------------------
Name | MRS. ZANETTA BELLAMY HARGETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-598-4300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 477
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------