Organization
PROVIDENCE EYE AND LASER SPECIALISTS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REY WILSON (OFFICE MANAGER)
(704) 540-9595
Entity
Organization
Contact information
Practice address
3025 SPRINGBANK LN, SUITE 200, CHARLOTTE, NC 28226-3362
(704) 540-9595
(704) 540-9616
Mailing address
3025 SPRINGBANK LN, SUITE 200, CHARLOTTE, NC 28226-3362
(704) 540-9595
(704) 540-9616
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2000-00102
NC
Other
Enumeration date
06/20/2006
Last updated
10/16/2012
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