MEDICARE: METROLINA EYE ASSOCIATES, PLLC

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1881173219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROLINA EYE ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	630 COMFORT LN
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28112-6199
Country	:	US
Telephone Number	:	704-289-5455
Fax Number	:	704-291-2207

Provider Business Practice Location Address
First Line	:	8816 UNIVERSITY EAST DR STE C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-4109
Country	:	US
Telephone Number	:	704-549-9999
Fax Number	:	704-549-5565

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	LARRY M HIGH
Credential	:
Telephone Number	:	704-334-2020

Provider Enumeration Date	:	08/07/2018
Last Update Date	:	08/07/2018

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