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General NPI Number Information
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NPI Number | 1962450098
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Entity Type | Organization
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Legal Business Name | POOLE EYECARE PA
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 808 W KING ST
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City | KINGS MTN
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State | NC
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Zip | 28086-2748
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Country | US
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Telephone | 704-739-5581
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Fax | 704-739-0000
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Provider Business Mailing Address
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Address Line | 808 W KING ST
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-2748
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Country | US
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Telephone | 704-739-5581
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Fax | 704-739-0000
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENJAMIN C POOLE
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Credential | OD
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Telephone | 704-739-5581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | NC1109
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License Number State | NC
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