MEDICARE: VISION CENTRAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	NC876	NC

General Provider Information

NPI Number	:	1275936700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION CENTRAL

Provider Business Mailing Address
First Line	:	2709 CENTRAL AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-5336
Country	:	US
Telephone Number	:	704-375-5585
Fax Number	:	704-375-5586

Provider Business Practice Location Address
First Line	:	2709 CENTRAL AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-5336
Country	:	US
Telephone Number	:	704-375-5585
Fax Number	:	704-375-5586

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. KAREN ALEXANDER
Credential	:
Telephone Number	:	704-375-5585

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	09/29/2014

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Directions to “VISION CENTRAL ” Practice Location

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