Organization
SOUTH FORK OPTOMETRIC ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH FAULK (PRESIDENT)
(704) 394-3886
Entity
Organization
Contact information
Practice address
9820 CALLABRIDGE CT, CHARLOTTE, NC 28216-7669
(704) 394-3886
Mailing address
307 ETHAN LN, BELMONT, NC 28012-4116
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2255
NC
152W00000X
Optometrist
Primary
2328
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02917
DAVIS
NC
01
—
0938G
BCBS
NC
01
—
17174
AVESIS
NC
01
—
1741X
BCBS
NC
01
—
A12474
EYEMED
NC
01
—
A16758
EYEMED
NC
Enumeration date
01/14/2015
Last updated
01/14/2015
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