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General NPI Number Information
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NPI Number | 1750456836
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Entity Type | Organization
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Legal Business Name | MCKINNON EYE CLINIC PA
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 1835 DAVIE AVENUE SUITE 413
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City | STATESVILLE
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State | NC
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Zip | 28677
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Country | US
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Telephone | 704-873-1463
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Fax | 704-873-1467
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Provider Business Mailing Address
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Address Line | PO BOX 991
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City | STATESVILLE
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State | NC
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Zip | 28687
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Country | US
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Telephone | 704-873-1463
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Fax | 704-873-1467
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVE M MCKINNON
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Credential | MD
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Telephone | 704-873-1463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 27825
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License Number State | NC
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