Organization
CAROLINA FAMILY EYE CARE OD PLLC
Active
Other names
Vision Source Studio 20/20
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMIR KHOSHNEVIS OD (PHYSICIAN/OWNER)
(704) 295-0123
Entity
Organization
Contact information
Practice address
2424 W MALLARD CREEK CHURCH RD, STE D, CHARLOTTE, NC 28262-5800
(704) 295-0123
(704) 510-9239
Mailing address
2424 W MALLARD CREEK CHURCH RD, STE D, CHARLOTTE, NC 28262-5800
(704) 295-0123
(704) 510-9239
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1714
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017GH
BLUE CROSS BLUE SHIELD
NC
01
—
1346242781
NPI
NC
05
—
89093JG
—
NC
Enumeration date
10/03/2006
Last updated
06/05/2020
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