MEDICARE: POOLE EYECARE PA

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	NC1109	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962450098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POOLE EYECARE PA

Provider Business Mailing Address
First Line	:	808 W KING ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-2748
Country	:	US
Telephone Number	:	704-739-5581
Fax Number	:	704-739-0000

Provider Business Practice Location Address
First Line	:	808 W KING ST
Second Line	:
City	:	KINGS MTN
State	:	NC
Zip	:	28086-2748
Country	:	US
Telephone Number	:	704-739-5581
Fax Number	:	704-739-0000

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BENJAMIN C POOLE
Credential	:	OD
Telephone Number	:	704-739-5581

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	02/14/2024

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Directions to “POOLE EYECARE PA ” Practice Location

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