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General NPI Number Information
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NPI Number | 1588787105
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Entity Type | Organization
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Legal Business Name | 2020 EYE CARE CENTER
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 322 E STATESVILLE AVE
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City | MOORESVILLE
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State | NC
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Zip | 28115-2594
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Country | US
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Telephone | 704-664-1124
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1524
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City | MOORESVILLE
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State | NC
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Zip | 28115-1524
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Country | US
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Telephone | 704-664-1124
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS WILLIAM EARL LASSITER JR.
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Credential |
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Telephone | 704-664-1124
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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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