Organization
INNOVATIVE EYE CARE OD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE KATHLEEN MUMFORD O.D. (OWNER)
(704) 348-1500
Entity
Organization
Contact information
Practice address
1710 KENILWORTH AVE, SUITE 210, CHARLOTTE, NC 28203-5256
(704) 348-1500
Mailing address
1710 KENILWORTH AVE, SUITE 210, CHARLOTTE, NC 28203-5256
(704) 348-1500
(704) 919-0289
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2225
NC
Other
Enumeration date
09/29/2011
Last updated
02/28/2012
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