Organization
SAPOUNAS OPTICAL GROUP, LLC
Active
Other names
My Eye Lab
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE BENNETT (CREDENTIALING SPECIALIST)
(561) 433-6009
Entity
Organization
Contact information
Practice address
4704 SOUTH BLVD STE A, CHARLOTTE, NC 28217-2745
(561) 275-2020
Mailing address
228 HEATHER GLEN DR, BOILING SPRINGS, SC 29316-5939
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
11/20/2018
Last updated
11/20/2018
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