Organization
CHARLOTTE OPTOMETRIC CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MASHERRILL KOONCE O.D. (OPTOMETRIST)
(704) 341-7676
Entity
Organization
Contact information
Practice address
9425 SOUTH BLVD STE A, CHARLOTTE, NC 28273-6900
(704) 341-7676
(704) 370-9751
Mailing address
9425 SOUTH BLVD STE A, CHARLOTTE, NC 28273-6900
(704) 341-7676
(704) 370-9751
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1393
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5918202
—
NC
05
—
890920G
—
NC
Enumeration date
11/26/2007
Last updated
11/21/2023
Update your record
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