Organization
BLACK OPTOMETRIC EYE ASSOCIATES,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBORAH BLACK O.D. (PRESIDENT/OWNER)
(704) 847-9833
Entity
Organization
Contact information
Practice address
518 W JOHN ST, MATTHEWS, NC 28105-5353
(704) 847-9833
Mailing address
518 W JOHN ST, MATTHEWS, NC 28105-5353
(704) 847-9833
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1176
NC
332H00000X
Eyewear Supplier
1176
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8909106
—
NC
Enumeration date
04/22/2008
Last updated
02/21/2010
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