Organization
CHARLOTTE OPHTHALMOLOGY CLINIC P.A.
Active
Organization
CHARLOTTE OPHTHALMOLOGY CLINIC P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON C WHITESIDE (PRESIDENT)
(704) 895-8200
Entity
Organization
Contact information
Practice address
16610 BIRKDALE COMMONS PKWY STE A, HUNTERSVILLE, NC 28078-5646
(704) 895-8200
(704) 997-8708
Mailing address
16610 BIRKDALE COMMONS PKWY STE A, HUNTERSVILLE, NC 28078-5646
(704) 895-8200
(704) 997-8708
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0269V
BLUE CROSS BLUE SHIELD
NC
Enumeration date
06/13/2007
Last updated
09/24/2020
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