Individual
DR. MICHELLE KATHLEEN MUMFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1710 KENILWORTH AVE STE 210, CHARLOTTE, NC 28203-0008
(704) 348-1500
Mailing address
1710 KENILWORTH AVE, SUITE 210, CHARLOTTE, NC 28203-5256
(704) 348-1500
(704) 919-0289
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2225
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NC2110A342
MEDICARE PTAN
NC
Enumeration date
01/14/2009
Last updated
10/05/2021
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