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General NPI Number Information
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NPI Number | 1821026980
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Entity Type | Individual
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Provider Name | THOMAS K MUNDORF MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 1718 E 4TH ST STE 908
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City | CHARLOTTE
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State | NC
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Zip | 28204-3281
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Country | US
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Telephone | 704-334-3222
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Fax | 704-334-1532
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Provider Business Mailing Address
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Address Line | 1718 E 4TH ST STE 908
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City | CHARLOTTE
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State | NC
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Zip | 28204-3281
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Country | US
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Telephone | 704-334-3222
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Fax | 704-334-1532
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 27495
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License Number State | NC
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