Individual
DR. AUDREY LAKE HOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
7745 BALLANTYNE COMMONS PKWY, SUITE 101, CHARLOTTE, NC 28277-2442
(704) 841-3937
(704) 841-3964
Mailing address
7745 BALLANTYNE COMMONS PKWY, SUITE 101, CHARLOTTE, NC 28277-2442
(704) 841-3937
(704) 841-3964
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1260
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05415
SPECTERA
NC
01
—
093HT
BCBS
NC
01
—
28916
COMMUNITY EYE CARE
NC
Enumeration date
01/26/2007
Last updated
02/06/2009
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